Emergency CT misdiagnosis in acute aortic syndrome
John G Dreisbach1,2, Jonathan Cl Rodrigues3, Giles Roditi2
1Department of Radiology, Golden Jubilee National Hospital, Clydebank, United Kingdom.
Insights
Emergency CT scans for acute aortic syndrome (AAS) often have discrepancies, particularly when interpreted by non-specialists. Specialist review is crucial for accurate diagnosis and to avoid misinterpretations in AAS cases.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Emergency Medicine
Background:
- Acute aortic syndrome (AAS) is a life-threatening condition requiring prompt and accurate diagnosis.
- Computed tomography (CT) angiography is the primary imaging modality for AAS diagnosis.
- Accuracy of emergency CT reports in AAS is critical for timely patient management.
Purpose of the Study:
- To assess the accuracy of emergency CT reports in diagnosing acute aortic syndrome (AAS).
- To identify discrepancies in AAS diagnosis, complications, and classification on emergency CT.
- To evaluate the impact of radiologist specialization and clinical suspicion on CT accuracy.
Main Methods:
- Retrospective review of 88 confirmed AAS cases from January 2013 to December 2016.
- Two cardiovascular radiologists assessed CT studies and reports for discrepancies.
- Evaluation included diagnosis, complications, classification, reporter's specialist interest, clinical suspicion, and scan technical adequacy.
Main Results:
- Discrepancies were found in 31% of AAS cases, including missed diagnoses (15%) and misinterpretations.
- All discrepancies occurred in reports by non-specialist radiologists.
- 26% of AAS cases were not clinically suspected, impacting scan protocols and adequacy.
Conclusions:
- Significant discrepancies in emergency CT interpretation for AAS are common.
- Pitfalls in CT technique and interpretation highlight the need for improvement.
- Routine specialist cardiovascular imaging input is recommended for emergency AAS assessment.
Objectives:
This cross-sectional study assessed the accuracy of emergency CT reports at presentation in acute aortic syndrome (AAS).
Methods:
Retrospective identification of cases of AAS presenting within a large health board with three acute hospitals receiving adult patients between January 2013 and December 2016. CT studies and reports at presentation were reviewed for discrepancies related to diagnosis, complications and classification by two cardiovascular radiologists. The specialist interest of the original reporters, clinically suspected diagnosis at referral for CT and technical adequacy of the scans were also assessed. False-positive diagnoses were identified and evaluated separately.
Results:
Among 88 consecutive confirmed cases of AAS at least one discrepancy was identified in 31% (n = 27), including failure to identify or misinterpretation of the AAS itself in 15% (n = 13), haemorrhage in 13% (n = 11), branch involvement in 9% (n = 8), and misclassification in 3% (n = 3). All discrepancies occurred among the 80% (n = 70) of cases reported by radiologists without specialist cardiovascular interest. 26% (n = 23/88) of AAS cases were not clinically suspected at referral for CT and although this was associated with suboptimal protocols, only 51% of CT scans among suspected cases were technically adequate. Seven false-positive diagnoses were identified, three of which related to motion artefact.
Conclusion:
Significant discrepancies are common in the emergency CT assessment of positive cases AAS and this study highlights important pitfalls in CT technique and interpretation. The absence of discrepancies among radiologists with specialist cardiovascular interest suggests both suspected and confirmed cases warrant urgent specialist review.
Advances In Knowledge:
CT angiography is central to the diagnosis of AAS; however, significant radiology discrepancies are common among non-specialists. This study highlights important pitfalls in both CT technique as well as interpretation and supports routine specialist cardiovascular imaging input in the emergency assessment of AAS.
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