Yoshida Satoru, Akiba Hidenari, Tamakawa Mitsuharu, Yama Naoya, Hareyama Masato, Morishita Kiyofumi, Abe Tomio
Departments of Radiology and Cardiovascular Surgery, Sapporo Medical University, School of Medicine, Japan.
Radiology. 2003 Aug;228(2):430-5. doi: 10.1148/radiol.2282012162. Epub 2003 Jun 20.
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.
评估急诊螺旋计算机断层扫描（CT）对A型主动脉夹层（AD）和A型壁内血肿（IMH）胸部受累情况评估时各种表现的准确性，并将这些表现与手术证实的结果进行比较。
57例急性胸痛患者接受了急诊螺旋CT检查，随后接受了A型AD或IMH的手术治疗。在螺旋CT上检查了胸主动脉三个节段检测到AD或IMH的患者，或存在任何破口、弓部分支血管受累、心包积液或主动脉弓异常部位的患者。以手术证实为参考标准，计算螺旋CT的敏感性、特异性和准确性以及95%置信区间。
对于胸主动脉AD或IMH的检测，螺旋CT的准确性为100%。破口的敏感性、特异性和准确性分别为82%、100%和84%；弓部分支血管受累分别为95%、100%和98%；心包积液分别为83%、100%和91%。主动脉弓异常的这些值均为100%。
胸部急诊螺旋CT在评估急性A型AD和IMH时所显示的表现具有很高的准确性。
