Syndicate this blog
RSS feed

Archives
March 2009
December 2006
November 2006

TEE, helical CT, and MRI Equally Clinically Reliable at Diagnosing Thoracic Aortic Dissection

TEE, helical CT, and MRI Equally Clinically Reliable at Diagnosing Thoracic Aortic Dissection
Posted 2006-12-03 22:47:33
Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis.
 
 
Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y.
 
 
Department of Anesthesiology, Toho University Ohashi Medical Center, Tokyo, Japan. QZX02115@nifty.com
 
 
BACKGROUND: Patients with suspected thoracic aortic dissection require early and accurate diagnosis. Aortography has been replaced by less invasive imaging techniques including transesophageal echocardiography (TEE), helical computed tomography (CT), and magnetic resonance imaging (MRI); however, accuracies have varied from trial to trial, and which imaging technique should be applied to which risk population remains unclear. We systematically reviewed the diagnostic accuracy of these imaging techniques in patients with suspected thoracic aortic dissection. METHODS: Published English-language reports on the diagnosis of thoracic aortic dissection by TEE, helical CT, or MRI were identified from electronic databases. Sensitivity, specificity, and positive and negative likelihood ratios were pooled in a random-effects model. RESULTS: Sixteen studies involving a total of 1139 patients were selected. Pooled sensitivity (98%-100%) and specificity (95%-98%) were comparable between imaging techniques. The pooled positive likelihood ratio appeared to be higher for MRI (positive likelihood ratio, 25.3; 95% confidence interval, 11.1-57.1) than for TEE (14.1; 6.0-33.2) or helical CT (13.9; 4.2-46.0). If a patient had shown a 50% pretest probability of thoracic aortic dissection (high risk), he or she had a 93% to 96% posttest probability of thoracic aortic dissection following a positive result of each imaging test. If a patient had a 5% pretest probability of thoracic aortic dissection (low risk), he or she had a 0.1% to 0.3% posttest probability of thoracic aortic dissection following a negative result of each imaging test. CONCLUSION: All 3 imaging techniques, ie, TEE, helical CT, and MRI, yield clinically equally reliable diagnostic values for confirming or ruling out thoracic aortic dissection.
Share this link?   Digg!Digg   RedditReddit   del.icio.usDel.icio.us   

Please send sugestions and comments to kevin@ctsim.org.