Thoracic involvement of type A aortic dissection and intramural hematoma: diagnostic accuracy--comparison of emergency helical CT and surgical findings

Radiology. 2003 Aug;228(2):430-5. doi: 10.1148/radiol.2282012162. Epub 2003 Jun 20.


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.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Aortic Aneurysm, Thoracic / diagnostic imaging*
  • Aortic Aneurysm, Thoracic / surgery
  • Aortic Diseases / diagnostic imaging*
  • Aortic Diseases / surgery
  • Diagnosis, Differential
  • Emergencies
  • Female
  • Hematoma / diagnostic imaging*
  • Hematoma / surgery
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods*