Preoperative computed tomography or intraoperative epiaortic ultrasound for the diagnosis of atherosclerosis of the ascending aorta?
BACKGROUND
Extensive atherosclerotic disease, usually first diagnosed intraoperatively, is the most important risk factor for postoperative stroke after cardiac surgery. The aim of this study was to investigate if preoperative computed tomography (CT) is comparable with intraoperative epiaortic ultrasound to diagnose severe atherosclerosis in the ascending aorta.


METHODS
The study included 20 consecutive patients who underwent elective coronary artery bypass surgery. Preoperative CT evaluation of the ascending aorta was compared with intraoperative epiaortic ultrasound findings. The ascending aorta was divided into 12 segments per patient, giving 240 segments to compare.


RESULTS
Epiaortic ultrasound detected atherosclerosis in 16.7% +/- 2.4% of the segments, a rate significantly higher than with CT ( P < or =.03). There was a low reliability between the 2 methods, indicated by kappa coefficients of 0.45 or lower.


CONCLUSIONS
The CT method is inferior to epiaortic ultrasound, today's gold standard, in diagnosing the extent and location of atherosclerosis of the ascending aorta. Other methods, possibly magnetic resonance imaging, should be considered.
Bergman
Per
P
Department of Cardiothoracic Surgery, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden. per.bergman@hs.se
van der Linden
Jan
J
Forsberg
Kenneth
K
Ohman
Mattias
M
D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging*; D001027:Aortography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*