Thoracic involvement of type A aortic dissection and intramural hematoma: diagnostic accuracy--comparison of emergency helical CT and surgical findings

• Published in: Radiology Vol. 228; no. 2; p. 430
• Main Authors: Yoshida, Satoru, Akiba, Hidenari, Tamakawa, Mitsuharu, Yama, Naoya, Hareyama, Masato, Morishita, Kiyofumi, Abe, Tomio
• Format: Journal Article
• Language: English
• Published: United States 01-08-2003
• Subjects: Adult; Aged; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - surgery; Aortic Diseases - diagnostic imaging; Aortic Diseases - surgery; Diagnosis, Differential; Emergencies; Female; Hematoma - diagnostic imaging; Hematoma - surgery; Humans; Male; Middle Aged; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed - methods
• ISSN: 0033-8419
• DOI: 10.1148/radiol.2282012162

To assess the accuracy of various findings at emergency helical computed tomography (CT) for the evaluation of thoracic involvement of type A aortic dissection (AD) and type A intramural hematoma (IMH) and to compare these findings with those at surgical confirmation.
Fifty-seven patients with acute chest pain underwent emergency helical CT and subsequent surgery for type A AD or IMH. Patients in whom AD or IMH was detected in three segments of the thoracic aorta or those in whom there was a site of any entry tear, arch branch vessel involvement, pericardial effusion, or aortic arch anomaly were examined at helical CT. Sensitivity, specificity, and accuracy of helical CT, along with 95% CIs, were calculated by using surgical confirmation as the reference standard.
For the detection of AD or IMH of the thoracic aorta, the accuracy of helical CT was 100%. The sensitivity, specificity, and accuracy, respectively, were 82%, 100%, and 84% for an entry tear; 95%, 100%, and 98% for arch branch vessel involvement; and 83%, 100%, and 91% for pericardial effusion. These values were all 100% for aortic arch anomalies.
Emergency helical CT of the thorax depicts findings that are highly accurate in the evaluation of acute type A AD and IMH.