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Thoracic Involvement of Type A Aortic Dissection and Intramural Hematoma: Diagnostic Accuracy—Comparison of Emergency Helical CT and Surgical Findings¹

¹ From the Departments of Radiology (S.Y., H.A., M.T., N.Y., M.H.) and Cardiovascular Surgery (K.M., T.A.), Sapporo Medical University, School of Medicine, Japan. From the 1999 RSNA scientific assembly. Received January 14, 2002; revision requested March 5; final revision received September 9; accepted December 10. Address correspondence to S.Y., Department of Radiology, Muroran City General Hospital, Yamate-chou 3-8-1, Muroran 051-8512, Japan (e-mail: satyoshi@chive.ocn.ne.jp).

PURPOSE: To assess the accuracy of various findings at emergency helical computed tomography (CT) for the evaluation of thoracic involvement of type A aortic dissection (AD) and type A intramural hematoma (IMH) and to compare these findings with those at surgical confirmation.

MATERIALS AND METHODS: Fifty-seven patients with acute chest pain underwent emergency helical CT and subsequent surgery for type A AD or IMH. Patients in whom AD or IMH was detected in three segments of the thoracic aorta or those in whom there was a site of any entry tear, arch branch vessel involvement, pericardial effusion, or aortic arch anomaly were examined at helical CT. Sensitivity, specificity, and accuracy of helical CT, along with 95% CIs, were calculated by using surgical confirmation as the reference standard.

RESULTS: For the detection of AD or IMH of the thoracic aorta, the accuracy of helical CT was 100%. The sensitivity, specificity, and accuracy, respectively, were 82%, 100%, and 84% for an entry tear; 95%, 100%, and 98% for arch branch vessel involvement; and 83%, 100%, and 91% for pericardial effusion. These values were all 100% for aortic arch anomalies.

CONCLUSION: Emergency helical CT of the thorax depicts findings that are highly accurate in the evaluation of acute type A AD and IMH.

© RSNA, 2003

Index terms: Aorta, CT, 56.12111, 56.12112, 56.12115 • Aorta, dissection, 56.74 • Computed tomography (CT), helical, 56.12111, 56.12112, 56.12115

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