title: Diagnostic utility of unenhanced computed tomography for acute aortic syndrome.
abstract: BACKGROUND
  The diagnostic value of unenhanced computed tomography (CT) for diagnosing acute aortic dissection (AAD) and ruptured thoracic aortic aneurysm (TAA) remains unclear.
  
  
  RESULTS
  We examined 219 consecutive patients who visited the emergency room with suspected acute aortic syndrome (AAS) because of chest or back pain and who underwent both unenhanced and contrast-enhanced 64-row multi-detector CT. The unenhanced CT findings were evaluated by the cardiologist on duty who was blind to the findings of contrast-enhanced CT. Diagnosis of AAS was confirmed in 103 patients (47%, 95 AAD and 8 ruptured TAA patients) based on evaluation of both unenhanced and contrast-enhanced CT images, which was used as the reference standard for validating the diagnostic value of the unenhanced CT findings. Sensitivity and specificity of the findings of a high-attenuation crescent, which represents hematoma in the aortic wall, were 61.2% and 99.1%, respectively. Sensitivity and specificity of linear high density in the aorta, which represents an intimal flap, were 59.2% and 96.6%, respectively. If unenhanced CT showed none of high-attenuation crescent, linear high density, internal displacement of intimal calcification, or TAA, the negative predictive value was 93.3%.
  
  
  CONCLUSIONS
  Unenhanced CT is a good tool for ruling AAS in, but the false-negative rate of 6.7% is high for ruling AAS out because it has to be the minimum possible.
authors.affiliation: Division of Cardiology, Yokohama City Minato Red Cross Hospital.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kurabayashi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Okishige
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ueshima
authors.forename: Kojiro
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Shimura
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Asano
authors.initials: A
authors.lastname: Mitsutoshi
authors.forename: Hideshi
authors.initials: H
authors.lastname: Aoyagi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Otani
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Isobe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001019:Aortic Rupture / Q000000981:diagnostic imaging*; D001027:Aortography; D004632:Emergency Medical Services; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015898:Tomography Scanners, X-Ray Computed