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


METHODS
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.


RESULTS
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.


CONCLUSIONS
Emergency helical CT of the thorax depicts findings that are highly accurate in the evaluation of acute type A AD and IMH.
Yoshida
Satoru
S
Departments of Radiology and Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Japan. satyoshi@chive.ocn.ne.jp
Akiba
Hidenari
H
Tamakawa
Mitsuharu
M
Yama
Naoya
N
Hareyama
Masato
M
Morishita
Kiyofumi
K
Abe
Tomio
T
D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000601:surgery; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D003937:Diagnosis, Differential; D004630:Emergencies; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*