Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Prediction of Intimal Tear Site by Computed Tomography in Acute Aortic Dissection Type A

  • Kim, Jun Sung (Department of Thoracic and Cardiovascular Surgery Seoul National University Bundang Hospital) ;
  • Park, Kay-Hyun (Department of Thoracic and Cardiovascular Surgery Seoul National University Bundang Hospital) ;
  • Lim, Cheong (Department of Thoracic and Cardiovascular Surgery Seoul National University Bundang Hospital) ;
  • Kim, Dong Jin (Department of Thoracic and Cardiovascular Surgery Seoul National University Bundang Hospital) ;
  • Jung, Yochun (Department of Thoracic and Cardiovascular Surgery Halla General Hospital) ;
  • Shin, Yoon Cheol (Department of Thoracic and Cardiovascular Surgery Seoul National University Bundang Hospital) ;
  • Choi, Sang Il (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Chun, Eun Ju (Department of Radiology, Seoul National University Bundang Hospital) ;
  • Yoo, Jin Young (Department of Radiology, Seoul National University Bundang Hospital)
  • Received : 2015.04.15
  • Accepted : 2015.08.17
  • Published : 2016.01.30
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Abstract

Background and Objectives: Preoperative identification of intimal tear site in acute type A dissection will help procedural planning. The objective of this study was to determine the key findings of computed tomography (CT)-based prediction for tear site and compare the accuracy between radiologists and surgeons. Subjects and Methods: Multi-detector CT (MDCT) images from 50 patients who underwent surgical repair of type A aortic dissection were retrospectively reviewed by 4 cardiac surgeons with limited experience or by 3 radiologists specialized in cardiovascular imaging. Surgical findings of intimal tear site were used as references. Results: In surgical findings, the locations of intimal tear that were identified in 43 patients included aorta (n=25), ascending with arch (n=7), and arch only (n=11). The rest were retrograde dissections from the tear of descending aorta. Key CT findings that were most frequently found were defect in the intimal flap shadow ($30.0{\pm}4.0$ patients/reviewer, accuracy $87.0{\pm}11.7%$) and differential filling of false lumen by phase and location ($9.4{\pm}2.9$ patients/reviewer, $84.8{\pm}10.4%$). Surgeons predicted tear site ($75.0{\pm}7.7%$ vs. $86.7{\pm}1.2%$, p=0.055) and specified flap defect ($80.5{\pm}10.3%$ vs. $95.7{\pm}7.4%$, p=0.073) with lower accuracy than radiologists. Conclusions: With MDCT imaging, well-educated surgeons could be accurate in three fourths of cases. There was room for improvement through experience. Considering the substantial possibility of inaccuracy, critical decisions on CT images should be made through thorough reviewing by as many experienced radiologists and surgeons as possible.

Keywords

Acknowledgement

Supported by : Seoul National University Bundang Hospital

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