M. Reiter

Die Rolle des Thoraxröntgens in der Diagnose des thorakalen Aortenaneurysmas

Objective: To evaluate the role of routine chest radiographs in the diagnosis of thoracic aortic aneurysms (TAA). Methods: An electronic full-text search was performed in our radiological information system for all patients who underwent chest radiograph under standard conditions between 1998 and 2000 and who had suspected widening or aneurysm of the thoracic aorta as a diagnosis. Computed tomography (CT) of the thorax was used as the gold standard and had to be performed within a period of 30 days. Two independent and blinded observers evaluated different morphologic and morphometric parameters in the diagnosis and correlated the results with those of CT. Results: 28 patients were included in the present trial. With almost perfect interobserver correlation (r=0.95) both investigated morphometric parameters correlated well (r=0.85 and 0.83) with the diameter of the aorta as evaluated with CT. While a low subjective over-all probability for TAA had a negative predictive value of 100%, we found that, despite an almost perfect interobserver variability (Kappa>0.8), none of the investigated morphologic parameters (discrepancy between the ascending and descending aorta, displacement of the trachea to the right and caudal displacement of the left main bronchus) was significantly correlated with the final diagnosis. Conclusion: The investigated morphometric parameters help to estimate the diameter of the aorta in the arch and in the descending section, but none of the morphologic criteria can be used for the diagnosis of TAA.