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Systematic Review and Meta-analysis

Toshiya Shiga, MD, PhD; Zen’ichiro Wajima, MD, PhD; Christian C. Apfel, MD, PhD; Tetsuo Inoue, MD, PhD; Yoko Ohe, MD, PhD

Arch Intern Med. 2006;166:1350-1356.

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 Aortography has been replaced by less invasive imaging techniques including transesophageal echocardiography (TEE), helical computed tomography (CT), and magnetic resonance imaging (MRI);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.

Author Affiliations: Department of Anesthesiology, Toho University Ohashi Medical Center, Tokyo, Japan (Drs Shiga and Ohe); Department of Anesthesia, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan (Drs Wajima and Inoue); and Department of Anesthesia and Preoperative Care, University of California at San Francisco (Dr Apfel).

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