von Kodolitsch Yskert, Nienaber Christoph A, Dieckmann Christoph, Schwartz Ann G, Hofmann Thomas, Brekenfeld Caspar, Nicolas Volkmar, Berger Jürgen, Meinertz Thomas
Department of Internal Medicine, University Hospital Eppendorf, Hamburg, Germany.
Am J Med. 2004 Jan 15;116(2):73-7. doi: 10.1016/j.amjmed.2003.08.030.
We sought to assess the diagnostic accuracy of routine chest radiography for the acute aortic syndrome (dissection, intramural hematoma, penetrating ulcer, or nondissecting aneurysm).
During a 6-year period, 216 patients (143 men, 73 women; mean [+/- SD] age, 58 +/- 17 years) underwent chest radiography for suspected acute aortic syndrome. Chest films were re-evaluated blindly for aortic disease, based on an overall impression using standard criteria such as widening of the aortic contour and mediastinal shadow. Findings were matched to tomographic images, anatomical inspection, or both, as the criterion standard; aortic disease was confirmed in 109 (50%) of the patients.
Chest radiography had a sensitivity of 64% (70/109) and a specificity of 86% (92/107) for aortic disease. Sensitivity was 67% (38/57) for overt aortic dissection, 61% (22/36) for nondissecting aneurysm, and 63% (10/16) for intramural hemorrhage or penetrating ulcer. However, sensitivity was lower for pathology confined to the proximal aorta (47% [21/45]) than for disease involving distal aortic segments (77% [49/64]). A receiver operating characteristic curve analysis of aortic diameters failed to identify a threshold for the diagnosis of aortic disease.
Chest radiography is of limited value for diagnosing the acute aortic syndrome, particularly for conditions confined to the ascending aorta. Since a definitive diagnosis is required in any patient with clinically suspected acute aortic syndrome, routine chest radiography should be replaced by tomographic aortic imaging.
我们旨在评估常规胸部X线摄影对急性主动脉综合征（夹层、壁内血肿、穿透性溃疡或非夹层动脉瘤）的诊断准确性。
在6年期间，216例患者（143例男性，73例女性；平均[±标准差]年龄，58±17岁）因疑似急性主动脉综合征接受了胸部X线摄影。根据主动脉轮廓增宽和纵隔阴影等标准，对胸部X线片进行盲法重新评估以判断主动脉疾病。将检查结果与断层图像、解剖检查或两者进行比对，作为标准参照；109例（50%）患者确诊患有主动脉疾病。
胸部X线摄影对主动脉疾病的敏感性为64%（70/109），特异性为86%（92/107）。对于明显的主动脉夹层，敏感性为67%（38/57）；对于非夹层动脉瘤，敏感性为61%（22/36）；对于壁内出血或穿透性溃疡，敏感性为63%（10/16）。然而，局限于主动脉近端的病变敏感性（47%[21/45]）低于累及主动脉远端节段的病变（77%[49/64]）。对主动脉直径进行的受试者工作特征曲线分析未能确定诊断主动脉疾病的阈值。
胸部X线摄影对诊断急性主动脉综合征价值有限，尤其是对于局限于升主动脉的情况。由于任何临床怀疑急性主动脉综合征的患者都需要明确诊断，常规胸部X线摄影应被主动脉断层成像所取代。
