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Chest X-Ray as a Screening Tool for Aortic Arch Dilation: CT-Based Evaluation of Reliability

Maciej Lis1,2, Robert Banyś1, Bernard Solewski1,2

  • 1Clinical Imaging Diagnostics Center, 5th Military Hospital with Polyclinic in Krakow, 30-901 Krakow, Poland.

Diagnostics (Basel, Switzerland)
|October 29, 2025
PubMed

Insights

Simple chest X-ray measurements of aortic knob width, along with age and sex, can help rule out aortic arch dilation. This may serve as a valuable screening tool for guiding further imaging decisions.

Area of Science:

  • Radiology
  • Cardiovascular Imaging
  • Thoracic Imaging

Background:

  • Chest radiography (CXR) is the primary imaging modality for thoracic abnormalities.
  • Aortic knob width on CXR may indicate aortic dilation, but lacks standardized clinical thresholds.
  • No established CXR criteria exist for reliably assessing aortic dilation.

Purpose of the Study:

  • To evaluate the utility of aortic knob width measurements on CXR for detecting aortic dilation.
  • To establish quantitative CXR thresholds for identifying thoracic abnormalities.
  • To assess the correlation between CXR and CT angiography measurements of the aorta.

Main Methods:

  • Retrospective analysis of 240 emergency department patients with PA CXR and CTA.
  • Measurement of three aortic knob dimensions (horizontal, oblique, vertical) on CXR.
  • Comparison of CXR measurements with CTA at proximal and distal aortic levels.

Main Results:

  • Horizontal aortic knob width showed the strongest correlation with CTA measurements.
  • A regression model using horizontal knob diameter, age, and sex achieved an AUC of 0.884 for detecting aortic dilation (>40 mm).
  • A conservative threshold yielded 100% sensitivity and 1.00 negative predictive value for excluding dilation.

Conclusions:

  • Quantitative CXR aortic knob width, age, and sex can aid in excluding aortic arch dilation.
  • This approach demonstrates high negative predictive value, potentially serving as a screening tool.
  • Further validation in diverse populations is needed to confirm its role in guiding advanced imaging decisions.

Keywords:
aortic arch dilationaortic knob widthchest X-raycomputed tomography angiographyscreening tool

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