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Can computed tomography scan findings predict "impending'' aneurysm rupture?

Tamer N Boules1, Christopher N Compton, Stephen F Stanziale

  • 1University of Pittsburgh Medical Center, Division of Vascular Surgery, PA 15213, USA.

Vascular and Endovascular Surgery
|February 4, 2006
PubMed
Summary

Computed tomography (CT) signs suggesting impending aortic aneurysm rupture are poor predictors of short-term events. Further research is needed to identify reliable indicators for early intervention in patients with aortic aneurysms.

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Area of Science:

  • Vascular Surgery
  • Radiology
  • Medical Imaging

Background:

  • Computed tomography (CT) findings are sometimes interpreted as indicating imminent aortic aneurysm rupture.
  • These signs are often incidentally found in asymptomatic patients, complicating management decisions.

Purpose of the Study:

  • To evaluate the predictive accuracy of CT-identified signs for short-term aortic aneurysm rupture.
  • To determine if CT findings alone are sufficient to warrant urgent intervention.

Main Methods:

  • Retrospective review of computerized medical records and CT scans from August 1994 to August 2004.
  • Analysis of 45 patients with aortic aneurysms and CT reports of "impending rupture".
  • Exclusion of patients with signs of leak or infected aneurysms; focus on 39 intact aneurysms.

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Main Results:

  • Only 2 out of 29 observed patients (6.9%) experienced rupture within 72 hours of the CT scan.
  • Ten patients underwent early elective repair, precluding observation for rupture.
  • The majority of patients (26/39) were observed without rupture for extended periods, with some undergoing later elective repair.

Conclusions:

  • CT signs suggestive of "impending rupture" have a low positive predictive value for short-term aortic aneurysm rupture.
  • Alternative terminology is recommended until more accurate predictors are identified.
  • These CT findings should be considered serious but do not solely justify immediate, urgent surgical intervention.