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Noninvasive evaluation of suspected thoracic aortic disease by contrast-enhanced computed tomography
Insights
Computed tomography (CT) offers a noninvasive alternative for diagnosing thoracic aortic disease, showing similar accuracy to invasive aortography. CT alone enabled appropriate management in 91% of patients, highlighting its clinical value.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Thoracic Surgery
Background:
- Traditional evaluation of suspected thoracic aortic disease relies on invasive aortography, posing associated risks to patients.
- Computed tomography (CT) has emerged as a noninvasive imaging modality for assessing the thoracic aorta.
- The clinical utility of CT in diagnosing thoracic aortic disease and guiding therapy requires thorough evaluation.
Purpose of the Study:
- To evaluate the clinical value of computed tomography (CT) in diagnosing suspected thoracic aortic disease.
- To compare the diagnostic accuracy of CT with aortography against confirmed diagnoses.
- To assess the impact of CT findings on patient management decisions.
Main Methods:
- Retrospective study comparing CT results with surgical, autopsy, or clinical follow-up data in 200 patients.
- Aortographic results from 51 patients were also compared with clinical evidence.
- Independent and blinded interpretation of CT and aortography findings.
Main Results:
- Diagnostic accuracy of CT (86%) and aortography (87%) were similar when confirmed by hard evidence.
- Excluding trauma cases, CT accuracy was 90% and aortography 86%.
- CT alone allowed for appropriate management in 91% of patients without acute blunt chest trauma.
Conclusions:
- Computed tomography (CT) demonstrates comparable diagnostic accuracy to aortography for suspected thoracic aortic disease.
- CT provides sufficient information for appropriate patient management in the majority of cases.
- CT serves as a valuable noninvasive tool for evaluating thoracic aortic disease.
Abstract:
Traditionally, suspected thoracic aortic disease has been evaluated by aortography, which has associated risks because it is invasive. With the introduction of computed tomography (CT), a noninvasive alternative has become available. In the present retrospective study, the potential clinical value of CT in providing correct diagnoses and pertinent information required for current therapies is evaluated. For this purpose, results of CT in 200 patients examined for suspected thoracic aortic disease were compared with "hard" (surgical and autopsy findings) or "soft" (follow-up clinical information) evidence of the true diagnoses. Aortographic results, available in 51 patients (26%), were also compared with available clinical evidence. Excluding inadequate examinations, the diagnostic accuracy of the independently and blindly interpreted results of CT and aortography were similar (86% and 87%, respectively) in patients with true diagnoses confirmed by hard evidence. When patients evaluated for aortic damage from acute blunt chest trauma were also excluded, the accuracy was 90% for CT and 86% for aortography. Specifically, CT was 83% and 67% accurate in proved (i.e., confirmed by hard evidence) type A and type B dissections, respectively (75% for both type A and B by aortography). In the 183 patients suspected of having thoracic aortic disease not attributable to acute blunt chest trauma and with follow-up information, 91% would have been managed appropriately based on their CT evaluation alone. In the subset of patients who underwent aortographic evaluation as well, 91% would have been managed appropriately based on aortography alone. The accuracy for combined CT and aortography was 94%.(ABSTRACT TRUNCATED AT 250 WORDS)