The role of aortic wall CT attenuation measurements for the diagnosis of acute aortic syndromes

Abstract Objectives To determine if measurements of aortic wall attenuation can improve the CT diagnosis of acute aortic syndromes. Methods CT reports from a ten year period were searched for acute aortic syndromes (AAS). Studies with both an unenhanced and a contrast enhanced (CTA) series that had...

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Bibliographic Details
Published in:European journal of radiology 2013-12, Vol.82 (12), p.2392-2398
Main Authors: Knollmann, Friedrich D, Lacomis, Joan M, Ocak, Iclal, Gleason, Thomas
Format: Article
Language:English
Subjects:
Acute Disease
Adult
Aged
Aged, 80 and over
Aneurysm, Dissecting - diagnostic imaging
Aorta
Aortic Aneurysm - diagnostic imaging
Aortography - methods
Atherosclerosis - diagnostic imaging
Computed tomography
Female
Hematoma
Hematoma - diagnostic imaging
Humans
Male
Middle Aged
Radiographic Image Interpretation, Computer-Assisted - methods
Radiographic Image Interpretation, Computer-Assisted - standards
Radiology
Reproducibility of Results
Sensitivity and Specificity
Syndrome
Tomography, X-Ray Computed - methods
Tomography, X-Ray Computed - standards
Young Adult
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Summary:Abstract Objectives To determine if measurements of aortic wall attenuation can improve the CT diagnosis of acute aortic syndromes. Methods CT reports from a ten year period were searched for acute aortic syndromes (AAS). Studies with both an unenhanced and a contrast enhanced (CTA) series that had resulted in the diagnosis of intramural hematoma (IMH) were reviewed. Diagnoses were confirmed by medical records. The attenuation of aortic wall abnormalities was measured. The observed attenuation threshold was validated using studies from 39 new subjects with a variety of aortic conditions. Results The term “aortic dissection” was identified in 1206, and IMH in 124 patients’ reports. IMH was confirmed in 31 patients, 21 of whom had both unenhanced and contrast enhanced images. All 21 had pathologic CTA findings, and no CTA with IMH was normal. Attenuation of the aortic wall was greater than 45 HUs on the CTA images in all patients with IMH. When this threshold was applied to the new group, sensitivity for diagnosing AAS was 100% (19/19), and specificity 94% (16/17). Addition of unenhanced images did not improve accuracy. Conclusions Measurements of aortic wall attenuation in CTA have a high negative predictive value for the diagnosis of acute aortic syndromes.
ISSN:0720-048X
1872-7727
DOI:10.1016/j.ejrad.2013.09.007