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A Comparison of Retrospective ECG-Gated CT and Surgical or Angiographical Findings in Acute Aortic Syndrome

Makoto Orii1, Misato Sone1, Jumpei Fujiwara2

  • 1Department of Radiology, Iwate Medical University.

International Heart Journal
|September 13, 2023
PubMed

Insights

Retrospective ECG-gated CT accurately detects intimal tears in aortic dissection and ulcer-like projections in intramural hematoma. Diastolic and systolic phases show similar detection accuracy for these conditions.

Area of Science:

  • Cardiovascular Imaging
  • Radiology
  • Medical Diagnostics

Background:

  • Establishing optimal cardiac phases for retrospective ECG-gated CT in aortic pathology is crucial for accurate diagnosis.
  • Intimal tears (IT) in aortic dissection (AD) and ulcer-like projections (ULP) in intramural hematoma (IMH) are key indicators requiring precise detection.
  • Current literature lacks consensus on the best cardiac phase for identifying these specific findings.

Purpose of the Study:

  • To compare the diagnostic accuracy of diastolic-phase versus systolic-phase retrospective ECG-gated CT for detecting IT in AD and ULP in IMH.
  • To evaluate the combined utility of both diastolic and systolic phases in improving detection rates.
  • To provide evidence-based recommendations for imaging protocols in acute aortic syndromes.

Main Methods:

  • Retrospective analysis of 81 patients undergoing emergency ECG-gated CT for AD or IMH.
  • Comparison of IT and ULP detection rates using solely diastolic-phase, solely systolic-phase, and combined diastolic-systolic phase imaging.
  • Surgical or angiographical confirmation served as the reference standard for accuracy assessment.

Main Results:

  • Overall detection accuracy for IT and ULP was high across all methods: 93% (diastolic), 94% (systolic), and 95% (combined).
  • No statistically significant differences were observed in detection accuracy among the diastolic-phase, systolic-phase, or combined-phase imaging (P = 0.55).
  • Specific analysis for IT in AD and ULP in IMH also revealed no significant differences in accuracy between the cardiac phases.

Conclusions:

  • Retrospective ECG-gated CT provides highly accurate detection of intimal tears in aortic dissection and ulcer-like projections in intramural hematoma.
  • The choice between diastolic-phase, systolic-phase, or combined-phase imaging does not significantly impact the diagnostic accuracy for these specific findings.
  • Current ECG-gated CT protocols are effective for diagnosing critical features of acute aortic syndromes, regardless of the specific cardiac phase utilized.

Keywords:
Aortic dissectionIntimal tearIntramural hematomaUlcer-like projection

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