■在计算机断层扫描血管造影(CTA)上对急性斯坦福A型主动脉夹层(AAD)的假阳性诊断仍然是一个问题,并可能导致实质性后果。鉴于心电图(ECG)门控CTA提供了更高的诊断安全性,可以假设,基于非ECG门控转诊前CTA诊断为AAD的院际转诊具有较高的假阳性诊断风险.
■我们回顾了一系列患者,其中基于非ECG门控转诊前CTA的AAD诊断随后被ECG门控CTA证明是错误的。导致误诊的文物,以及随后的诊断途径和假阳性诊断的后果进行了调查。
■在5名患者中,ECG门控的重复CTA显示转诊前扫描中的伪影,导致了假阳性诊断和急诊手术转诊。在第一种情况下,病人开始做手术。在随后的4个案例中,由于怀疑诊断为假阳性,因此订购了ECG门控CTA。我们发现,在每种情况下,ECG门控CTA而不是超声心动图都提供了足够的信息来排除AAD。转诊前非ECG门控扫描和ECG门控重复CTA之间的比较表明,广泛的伪影可能导致AAD的诊断。
■患者情况允许,在院际转诊中,如果对基于非ECG门控CTA的AAD诊断存在疑问,则ECG门控重复CTA的阈值应该较低.
UNASSIGNED: False-positive diagnosis of acute Stanford type A aortic dissection (AAD) on computed tomography angiography (CTA) is still an issue and may lead to substantial consequences. Given that electrocardiography (ECG)-gated CTA provides greater diagnostic safety, it may be assumed that interhospital referrals with a diagnosis of AAD based on non-ECG-gated pre-referral CTA carry an elevated risk of false-positive diagnosis.
UNASSIGNED: We reviewed a series of patients in whom a diagnosis of AAD based on non-ECG-gated pre-referral CTA was subsequently proven false by ECG-gated CTA. The artifacts that gave rise to the misdiagnosis, as well as the diagnostic pathways followed and the consequences of false-positive diagnosis were investigated.
UNASSIGNED: In 5 patients, ECG-gated repeat CTA revealed artifacts in the pre-referral scans that had led to false-positive diagnosis and referral for emergent surgery. In the first case, the patient proceeded to surgery. In 4 subsequent cases, ECG-gated CTA was ordered because a false-positive diagnosis was suspected. We found that ECG-gated CTA rather than echocardiography provided sufficient information to rule out AAD in each of these cases. Comparison between pre-referral non-ECG-gated scans and ECG-gated repeat CTA demonstrated the wide range of artifacts that may give rise to a diagnosis of AAD.
UNASSIGNED: Patient condition permitting, the threshold to ECG-gated repeat CTA should be low when doubt arises with regard to a diagnosis of AAD based on non-ECG-gated CTA in interhospital referrals.