Significance of systolic-phase imaging on full-phase ECG-gated CT angiography to detect intimal tears in aortic
Satoru Yanagaki1, Atsuro Masuda1, Hideki Ota1
1Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1-1, Sendai, 980-8574, Japan.
Insights
The systolic phase of electrocardiogram-gated computed tomography angiography (ECG-gated CTA) is more accurate for detecting intimal tears in aortic dissection than the diastolic phase. However, both phases are equally effective for identifying ulcer-like projections in intramural hematoma.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Thoracic Aorta Imaging
Background:
- Aortic dissection (AD) and intramural hematoma (IMH) are serious thoracic aorta conditions.
- Accurate detection of intimal tears (IT) and ulcer-like projections (ULP) is crucial for patient management.
- The optimal cardiac phase for retrospective ECG-gated CTA in diagnosing AD and IMH is not well-established.
Purpose of the Study:
- To compare the diagnostic accuracy of retrospective ECG-gated CTA for detecting IT in AD and ULP in IMH across different cardiac phases.
- To determine if specific cardiac phases offer superior visualization of key diagnostic markers in AD and IMH.
Main Methods:
- Retrospective analysis of 75 patients with thoracic AD and IMH.
- Evaluation of diagnostic performance for IT and ULP in the ascending aorta, aortic arch, and descending aorta.
- Comparison of detection rates between systolic and diastolic phases on retrospective ECG-gated CTA.
Main Results:
- Systolic phase (20%) showed significantly higher accuracy (64%) and sensitivity (69%) for detecting IT in AD compared to the diastolic phase (52% accuracy, 52% sensitivity; P=0.025).
- No significant difference was observed in the accuracy (83%), sensitivity (71%), or specificity (100%) for detecting ULP in IMH between cardiac phases.
- Systolic phase demonstrated superior detection of IT in AD, while diastolic phase had lower accuracy and sensitivity.
Conclusions:
- Single-diastolic-phase ECG-gated CTA may miss intimal tears in AD that are visible in the systolic phase.
- Full-phase ECG-gated CTA, particularly utilizing the systolic phase, may improve the detection of IT in AD.
- These findings are critical for optimizing treatment strategies in patients with AD and IMH.
Purpose:
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.
Materials And Methods:
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.
Results:
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.
Conclusion:
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.
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