Acute aortic syndromes

A second look at dual-phase CT

Andrew J. Lovy, Jessica K. Rosenblum, Jeffrey M. Levsky, Alla Godelman, Amin B. Zalta, Vineet R. Jain, Linda B. Haramati

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

OBJECTIVE. The purpose of this article is to assess the diagnostic performance of the unenhanced and contrast-enhanced phases separately in patients imaged with CT for suspected acute aortic syndromes. MATERIALS AND METHODS. All adults (n = 2868) presenting to our emergency department from January 1, 2006, through August 1, 2010, who underwent unenhanced and contrast-enhanced CT of the chest and abdomen for suspected acute aortic syndrome were retrospectively identified. Forty-five patients with acute aortic syndrome and 45 healthy control subjects comprised the study population (55 women; mean age, 61 ± 16 years). Unenhanced followed by contrast-enhanced CT angiography (CTA) images were reviewed. Contrastenhanced CTA examinations of case patients and control subjects with isolated intramural hematoma were reviewed. Radiation exposure was estimated by CT dose-length product. RESULTS. Forty-five patients had one or more CT findings of acute aortic syndrome: aortic dissection (n = 32), intramural hematoma (n = 27), aortic rupture (n = 10), impending rupture (n = 4), and penetrating atherosclerotic ulcer (n = 2). Unenhanced CT was 89% (40/45) sensitive and 100% (45/45) specific for acute aortic syndrome. Unenhanced CT was 94% (17/18) and 71% (10/14) sensitive for type A and type B dissection, respectively (p = 0.142). Contrast-enhanced CTA was 100% (8/8) sensitive for isolated intramural hematoma. Mean radiation effective dose was 43 ± 20 mSv. CONCLUSION. Unenhanced CT performed well in detection of acute aortic syndrome treated surgically, although its performance does not support its use in place of contrast-enhanced CTA. Unenhanced CT may be a reasonable first examination for rapid triage when IV contrast is contraindicated. Contrast-enhanced CTA was highly sensitive for intramural hematoma, suggesting that unenhanced imaging may not always be needed. Acute aortic syndrome imaging protocols should be optimized to reduce radiation dose.

Original languageEnglish (US)
Pages (from-to)805-811
Number of pages7
JournalAmerican Journal of Roentgenology
Volume200
Issue number4
DOIs
StatePublished - Apr 2013

Fingerprint

Hematoma
Dissection
Radiation
Aortic Rupture
Acute Abdomen
Triage
Ulcer
Hospital Emergency Service
Rupture
Healthy Volunteers
Thorax
Computed Tomography Angiography
Population

Keywords

  • Acute aortic syndrome
  • Aortic dissection
  • CT
  • Radiation exposure

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Acute aortic syndromes : A second look at dual-phase CT. / Lovy, Andrew J.; Rosenblum, Jessica K.; Levsky, Jeffrey M.; Godelman, Alla; Zalta, Amin B.; Jain, Vineet R.; Haramati, Linda B.

In: American Journal of Roentgenology, Vol. 200, No. 4, 04.2013, p. 805-811.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. The purpose of this article is to assess the diagnostic performance of the unenhanced and contrast-enhanced phases separately in patients imaged with CT for suspected acute aortic syndromes. MATERIALS AND METHODS. All adults (n = 2868) presenting to our emergency department from January 1, 2006, through August 1, 2010, who underwent unenhanced and contrast-enhanced CT of the chest and abdomen for suspected acute aortic syndrome were retrospectively identified. Forty-five patients with acute aortic syndrome and 45 healthy control subjects comprised the study population (55 women; mean age, 61 ± 16 years). Unenhanced followed by contrast-enhanced CT angiography (CTA) images were reviewed. Contrastenhanced CTA examinations of case patients and control subjects with isolated intramural hematoma were reviewed. Radiation exposure was estimated by CT dose-length product. RESULTS. Forty-five patients had one or more CT findings of acute aortic syndrome: aortic dissection (n = 32), intramural hematoma (n = 27), aortic rupture (n = 10), impending rupture (n = 4), and penetrating atherosclerotic ulcer (n = 2). Unenhanced CT was 89{\%} (40/45) sensitive and 100{\%} (45/45) specific for acute aortic syndrome. Unenhanced CT was 94{\%} (17/18) and 71{\%} (10/14) sensitive for type A and type B dissection, respectively (p = 0.142). Contrast-enhanced CTA was 100{\%} (8/8) sensitive for isolated intramural hematoma. Mean radiation effective dose was 43 ± 20 mSv. CONCLUSION. Unenhanced CT performed well in detection of acute aortic syndrome treated surgically, although its performance does not support its use in place of contrast-enhanced CTA. Unenhanced CT may be a reasonable first examination for rapid triage when IV contrast is contraindicated. Contrast-enhanced CTA was highly sensitive for intramural hematoma, suggesting that unenhanced imaging may not always be needed. Acute aortic syndrome imaging protocols should be optimized to reduce radiation dose.",
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