International Society For Minimally Invasive Cardiothoracic Surgery

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The Efficacy Of Electrocardiogram-gated Computed Tomography To Diagnose Of The Entry Site In Acute Stanford Type A Aortic Dissection
Ryoji Kinoshita, Susumu Manabe, Daiki Hirayama, Norihisa Yuge, Masahiro Oonuki, Kazunobu Hirooka.
Tsuchiura Kyodo General Hospital, Tsuchiura city, Ibaraki, Japan.

Background: In the decision making of the surgical treatment of acute aortic dissection, the detection of the entry site is considered important. However, its accurate detection is sometimes difficult, because the CT image is inevitable from the motion artifacts caused by the heartbeat. Electrocardiogram (ECG)-gated CT scanning can reduce such artifacts and may be useful in determining the entry site of aortic dissection.Methods: The accuracy of the entry site detection was compared between ECG-gated CT images (sync images) and non-gated CT images (async images). We extracted 20 CT images (9 sync and 11 async) from patents undergoing surgical repair of aortic dissection. Six physicians (2 cardiac surgeons, 2 radiologists, 2 medical interns), who were not informed the results of operations, participated the study. The examinee reviewed the CT images to determine the entry site of aortic dissection, and the answers were verified with the operative findings. The examinee scored each CT image according to the easiness of entry site identification into 5 scale. Results: The entry site was correctly determined in 22.7% for async images. The correction rate was improved to 70.4% for sync images (p<0.001). The difference was remarkable in medical interns or cardiac surgeons (async: 9.1% vs. sync: 63.9%), compared with in radiologists (50.0% vs. 83.3%). The average readability score was higher in sync images (async: 2.8 vs. sync: 4.5) Conclusion: The accurate detection of the entry site based on the conventional CT images may be difficult for nonprofessionals. ECG-gated CT scanning is considered useful to determine the entry site in aortic dissection.

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