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. 2022 Nov;37(11):1947-1956.
doi: 10.1007/s00380-022-02093-0. Epub 2022 May 15.

Significance of systolic-phase imaging on full-phase ECG-gated CT angiography to detect intimal tears in aortic dissection

Satoru Yanagaki  1 , Atsuro Masuda  1 , Hideki Ota  1 , Masatoshi Kojima  2 , Takashi Hattori  3 , Wahei Mihara  3 , Kei Takase  1 , Takuya Ueda  4
Affiliations

Significance of systolic-phase imaging on full-phase ECG-gated CT angiography to detect intimal tears in aortic dissection

Satoru Yanagaki et al. Heart Vessels. 2022 Nov.

Abstract

Purpose: For patients with aortic dissection (AD) and intramural hematoma (IMH), the optimal cardiac phase to detect intimal tears (IT) and ulcer-like projections (ULP) on retrospective electrocardiogram (ECG)-gated computed tomography angiography (CTA) remains unclear. The purpose of this study was to compare the accuracy of retrospective ECG-gated CTA for detecting IT in AD and ULP in IMH between each cardiac phase.

Materials and methods: A total of 75 consecutive patients with AD and IMH of the thoracic aorta were enrolled in this single-center retrospective study. The diagnostic performance to detect IT and ULP in the thoracic aortic regions (including the ascending aorta, aortic arch, and proximal and distal descending aorta) was compared in each cardiac phase on retrospective ECG-gated CTA.

Results: In the systolic phase (20%), the accuracy, sensitivity, and specificity to detect IT in AD was 64% (95% confidence interval [CI] 56-72%), 69% (95%CI 60-78%), and 25% (95%CI 3.3-45%), respectively. In the diastolic phase (70%), the accuracy, sensitivity, and specificity to detect IT in AD was 52% (95%CI 43-60%), 52% (95%CI 42-61%), and 50% (95%CI 25-75%), respectively. The accuracy to detect IT in AD on ECG-gated CTA was significantly higher in the systolic phase than that in the diastolic phase (P = 0.025). However, there were no differences in the accuracy (83%; 95%CI 78-89%), sensitivity (71%; 95%CI 62-80%), or specificity (100%; 95%CI 100%) to detect ULP in IMH between the cardiac cycle phases.

Conclusion: Although it is currently recommended for routine diagnosis of AD and IMH, single-diastolic-phase ECG-gated CTA has risk to miss some IT in AD that are detectable in the systolic phase on full-phase ECG-gated CTA. This information is critical for determining the optimal treatment strategy for AD.

Keywords: Aortic dissection; Intimal tear; Intramural hematoma; Retrospective ECG-gated CTA; Ulcer-like projection.

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Conflict of interest statement

Hideki Ota were supported by a research grant from Canon Medical Systems. The other authors report no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow diagram of the study participants
Fig. 2
Fig. 2
Images comparing retrospective ECG-gated CT angiography at each phase of the R-R interval in a 53-year-old man with acute aortic dissection
Fig. 3
Fig. 3
Segmentation of the thoracic aorta for assessment. (1) Ascending aorta, (2) aortic arch, (3) proximal descending aorta, and (4) distal descending aorta. The ascending aorta was defined from the origin of the right coronary artery to the origin of the brachiocephalic artery (zone 0 in thoracic endovascular aortic replacement [TEVAR]). The aortic arch was defined from the origin of the brachiocephalic artery to the origin of the left subclavian artery (zones 1–2 in TEVAR). The proximal descending aorta was defined from the origin of the left subclavian artery to the level of the pulmonary bifurcation (zone 3 in TEVAR). The distal descending aorta was defined from the level of the pulmonary bifurcation to the aortic hiatus of the diaphragm (zone 4 in TEVAR)
Fig. 4
Fig. 4
Accuracy for detection of intimal tears in aortic dissection (n = 33)
Fig. 5
Fig. 5
Accuracy for detection of intimal tears in aortic dissection at each anatomical region
See this image and copyright information in PMC

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