title: Prediction of Intimal Tear Site by Computed Tomography in Acute Aortic Dissection Type A.
abstract: OBJECTIVE
  Preoperative identification of intimal tear site in acute type A dissection will help procedural planning. The objective of this study was to determine the key findings of computed tomography (CT)-based prediction for tear site and compare the accuracy between radiologists and surgeons.
  
  
  METHODS
  Multi-detector CT (MDCT) images from 50 patients who underwent surgical repair of type A aortic dissection were retrospectively reviewed by 4 cardiac surgeons with limited experience or by 3 radiologists specialized in cardiovascular imaging. Surgical findings of intimal tear site were used as references.
  
  
  RESULTS
  In surgical findings, the locations of intimal tear that were identified in 43 patients included aorta (n=25), ascending with arch (n=7), and arch only (n=11). The rest were retrograde dissections from the tear of descending aorta. Key CT findings that were most frequently found were defect in the intimal flap shadow (30.0±4.0 patients/reviewer, accuracy 87.0±11.7%) and differential filling of false lumen by phase and location (9.4±2.9 patients/reviewer, 84.8±10.4%). Surgeons predicted tear site (75.0±7.7% vs. 86.7±1.2%, p=0.055) and specified flap defect (80.5±10.3% vs. 95.7±7.4%, p=0.073) with lower accuracy than radiologists.
  
  
  CONCLUSIONS
  With MDCT imaging, well-educated surgeons could be accurate in three fourths of cases. There was room for improvement through experience. Considering the substantial possibility of inaccuracy, critical decisions on CT images should be made through thorough reviewing by as many experienced radiologists and surgeons as possible.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jun Sung
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Kay-Hyun
authors.initials: KH
authors.lastname: Park
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Cheong
authors.initials: C
authors.lastname: Lim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Halla General Hospital, Jeju, Korea.
authors.forename: Yochun
authors.initials: Y
authors.lastname: Jung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Yoon Cheol
authors.initials: YC
authors.lastname: Shin
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Sang Il
authors.initials: SI
authors.lastname: Choi
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Chun
authors.affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Yoo
keywords: Aorta; Aortic dissection; Computerized tomography