Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
Departments of Radiology, Seikeikai Chiba Medical Center, 1-7-1, Minami-cho, Chuo-ku, Chiba, 260-0842, Japan.
Heart Vessels. 2022 Nov;37(11):1947-1956. doi: 10.1007/s00380-022-02093-0. Epub 2022 May 15.
For patients with aortic dissection (AD) and intramural hematoma (IMH), the optimal cardiac phase to detect intimal tears (IT) and ulcer-like projections (ULP) on retrospective electrocardiogram (ECG)-gated computed tomography angiography (CTA) remains unclear. The purpose of this study was to compare the accuracy of retrospective ECG-gated CTA for detecting IT in AD and ULP in IMH between each cardiac phase.
A total of 75 consecutive patients with AD and IMH of the thoracic aorta were enrolled in this single-center retrospective study. The diagnostic performance to detect IT and ULP in the thoracic aortic regions (including the ascending aorta, aortic arch, and proximal and distal descending aorta) was compared in each cardiac phase on retrospective ECG-gated CTA.
In the systolic phase (20%), the accuracy, sensitivity, and specificity to detect IT in AD was 64% (95% confidence interval [CI] 56-72%), 69% (95%CI 60-78%), and 25% (95%CI 3.3-45%), respectively. In the diastolic phase (70%), the accuracy, sensitivity, and specificity to detect IT in AD was 52% (95%CI 43-60%), 52% (95%CI 42-61%), and 50% (95%CI 25-75%), respectively. The accuracy to detect IT in AD on ECG-gated CTA was significantly higher in the systolic phase than that in the diastolic phase (P = 0.025). However, there were no differences in the accuracy (83%; 95%CI 78-89%), sensitivity (71%; 95%CI 62-80%), or specificity (100%; 95%CI 100%) to detect ULP in IMH between the cardiac cycle phases.
Although it is currently recommended for routine diagnosis of AD and IMH, single-diastolic-phase ECG-gated CTA has risk to miss some IT in AD that are detectable in the systolic phase on full-phase ECG-gated CTA. This information is critical for determining the optimal treatment strategy for AD.
对于主动脉夹层（AD）和壁内血肿（IMH）患者，在回顾性心电图（ECG）门控计算机断层血管造影（CTA）中检测内膜撕裂（IT）和溃疡样突起（ULP）的最佳心脏相位仍不清楚。本研究的目的是比较各心脏相位下回顾性 ECG 门控 CTA 检测 AD 中 IT 和 IMH 中 ULP 的准确性。
本研究为单中心回顾性研究，共纳入 75 例连续的胸主动脉 AD 和 IMH 患者。在回顾性 ECG 门控 CTA 上比较各心脏相位检测胸主动脉区域（包括升主动脉、主动脉弓、近端和远端降主动脉）中 IT 和 ULP 的诊断性能。
在收缩期（20%），AD 中 IT 的检测准确性、敏感性和特异性分别为 64%（95%置信区间[CI] 56-72%）、69%（95%CI 60-78%）和 25%（95%CI 3.3-45%）。在舒张期（70%），AD 中 IT 的检测准确性、敏感性和特异性分别为 52%（95%CI 43-60%）、52%（95%CI 42-61%）和 50%（95%CI 25-75%）。ECG 门控 CTA 检测 AD 中 IT 的准确性在收缩期明显高于舒张期（P=0.025）。然而，在心脏周期各相位检测 IMH 中 ULP 的准确性（83%；95%CI 78-89%）、敏感性（71%；95%CI 62-80%）或特异性（100%；95%CI 100%）均无差异。
尽管目前推荐用于 AD 和 IMH 的常规诊断，但单舒张期 ECG 门控 CTA 有漏诊在全相位 ECG 门控 CTA 收缩期可检测到的一些 AD 中 IT 的风险。这些信息对于确定 AD 的最佳治疗策略至关重要。
