Diagnostic Accuracy

The accuracy of CT for detection of aortic dissection and classification as either type A or type B has been evaluated for single-slice CT, yielding a specificity between 94% and 100%5,13,29,30 and a sensitivity from 93% to 100%1,5,29,30. Moore et al. evaluated the patient records of 628 patients enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 1999, 618 of whom had imaging studies performed1. In this study, CT was more sensitive than transesophageal echocardiography (TEE)

Figure 5.9. Multiplanar reformatted contrast-enhanced CT images after replacement of the ascending thoracic aorta and aortic arch with a graft that extends into the descending thoracic aorta using elephant trunk technique: (a) sagittal oblique reformatted image; (b) axial reformatted image at the level of the graft of the aortic arch and proximal descending thoracic aorta. The graft is indicated by the thin black arrow. There is a partially thrombosed aneurysm of the proximal descending thoracic aorta surrounding the graft (thin white arrow). There is retrograde flow of contrast into the aneurysm (white arrowhead); the descending thoracic aorta distal to the graft is indicated by the black arrowhead. The appearance is entirely due to the presence of the graft within the aneurysm of the descending thoracic aorta, and there is no dissection.

Figure 5.9. Multiplanar reformatted contrast-enhanced CT images after replacement of the ascending thoracic aorta and aortic arch with a graft that extends into the descending thoracic aorta using elephant trunk technique: (a) sagittal oblique reformatted image; (b) axial reformatted image at the level of the graft of the aortic arch and proximal descending thoracic aorta. The graft is indicated by the thin black arrow. There is a partially thrombosed aneurysm of the proximal descending thoracic aorta surrounding the graft (thin white arrow). There is retrograde flow of contrast into the aneurysm (white arrowhead); the descending thoracic aorta distal to the graft is indicated by the black arrowhead. The appearance is entirely due to the presence of the graft within the aneurysm of the descending thoracic aorta, and there is no dissection.

but less sensitive than MR imaging for the detection of aortic dissection: Overall sensitivities were 88% (TEE), 93% (CT), 100% (MRI), and 87% (conventional angiography). For type A dissection, sensitivities were 90% (TEE), 93% (CT), 100% (MRI), and 87% (conventional angiography). For type B dissection, sensitivities were 80% (TEE), 93% (CT), 100% (MRI), and 89% (conventional angiography). Excluding cases of intramural hematoma (IMH), overall sensitivity was 87% for TEE, 93% for CT, 100% for MRI, and 88% for conventional angiography. Currently, there is no published research that evaluates the accuracy of multidetector CT for evaluation of aortic dissection.

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