Can the unenhanced phase be eliminated from dual-phase CT angiography for chest pain? implications for diagnostic accuracy in acute aortic intramural hematoma

Alessandro A. Lemos, John C. Pezzullo, Pierangelo Fasani, Marta Gullo, Caterina Giannitto, Roberto Lo Gullo, Pietro R. Biondetti

Research output: Contribution to journalArticle

Abstract

OBJECTIVE. The purposes of this study were to retrospectively assess the frequency of acute aortic intramural hematoma and evaluate whether the elimination of the unenhanced imaging acquisition series from the dual-phase MDCT angiography (CTA) protocol for chest pain might affect diagnostic accuracy in detecting intramural hematoma and justify the reduced radiation dose. MATERIALS AND METHODS. From October 2006 to November 2012, 306 patients (mean age, 65.0 years) with acute chest pain underwent emergency CTA with a 64-MDCT scanner. Two experienced cardiovascular radiologists, blinded to the diagnosis, assessed the images in two different sessions in which enhanced (single-phase CTA) and combined unenhanced and contrast-enhanced (dual-phase CTA) findings were evaluated. Sensitivity, specificity, and accuracy along with 95% CIs were calculated. Surgical and pathologic diagnoses, including findings at clinical follow-up and any subsequent imaging modality, were used as reference standards. RESULTS. Thirty-six patients were suspected of having intramural hematoma; 16 patients underwent both surgery and transesophageal echocardiography (TEE), and the remaining 20 underwent TEE. Single-phase CTA showed a higher number of false-negative and false-positive results than dual-phase CTA. With intramural hematoma frequency of 12% (95% CI, 8.38-15.91%), sensitivity, specificity, and accuracy were 94.4% (81.3-99.3%), 99.3% (97.4-99.9%), and 98.7% (96.7-99.6%) for combined dual-phase CTA and 68.4% (51.4-82.5%), 96.3% (93.2-98.2%), and 92.8% (89.3-95.4%) for single-phase CTA. Dualphase was significantly better than single-phase CTA with respect to sensitivity (p = 0.002), specificity (p = 0.008), overall accuracy (p

Original languageEnglish
Pages (from-to)1171-1180
Number of pages10
JournalAmerican Journal of Roentgenology
Volume203
Issue number6
DOIs
Publication statusPublished - Dec 1 2014

Keywords

  • Acute chest pain
  • Aortic intramural hematoma
  • CT angiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Fingerprint Dive into the research topics of 'Can the unenhanced phase be eliminated from dual-phase CT angiography for chest pain? implications for diagnostic accuracy in acute aortic intramural hematoma'. Together they form a unique fingerprint.

  • Cite this