A low threshold to ECG-gated repeat CTA reduces the risk of false-positive diagnosis of type A dissection in interhospital referrals: a case series study

Figures & data

Figure 1 (A) and (C) showing non-ECG-gated prereferral CTA suggesting aortic dissection in patient 1; (B) and (D) showing postoperative scan acquired in gated high-pitch mode and with subsecond level acquisition time.

Abbreviations: CTA, computed tomography angiography; ECG, electrocardiography.

Table 1 Laboratory findings at admission

Parameter	Patient 1	Patient 2	Patient 3	Patient 4	Patient 5
D-dimer (µg/L)	Not done	Not done	32,832	Not done	Not done
Creatinine (mg/dL)	0.67	2.6	0.81	0.85	0.77
WBC (/nL)	9.12	12.77	11.98	6.51	7.45
CPK U/L	103	127	153	84	79

Abbreviations: CPK, creatine phosphokinase; WBC, white blood cell.

Figure 2 (A) and (C) showing non-ECG-gated prereferral CTA suggesting circumferential dissection of the ascending aorta in patient 2; (B) and (D) showing gated repeat CTA without misleading artifacts.

Abbreviations: CTA, computed tomography angiography; ECG, electrocardiography.

Figure 3 (A) Non-ECG-gated prereferral CTA suggessting dissection of the ascending and descending aorta and (B) ECG-gated repeat CTA confirming only type B dissection in patient 4. (C) Suspicious structures at the level of the proximal ascending aorta in the non-ECG-gated prereferral scan of patient 3 that are absent in the ECG-gated repeat scan shown in (D).

Abbreviations: CTA, computed tomography angiography; ECG, electrocardiography.

Figure 4 (A) and (C) showing non-ECG-gated axial and coronal CTA images suggesting dissection at the level of the aortic root in patient 5. (B) and (D) showing the ECG-gated CT scan of the same patient subsequently performed on a 256-MSCT device that showed no aortic dissection.

Abbreviations: CTA, computed tomography angiography; ECG, electrocardiography; MSCT, multislice CT.