Objective:To evaluate the application of non-enhanced computed tomography (CT)in Emergency Department (ED)patients with suspected aortic dissection (AD).Methods:Of 127 ED patients with clinical suspicion of AD who underwent CT,AAD was confirmed in 57 and ruled out in 70.Non-enhanced CT data of all patients were retrospectively assessed by 2 independent observers unaware of clinical information and contrastenhanced CT data.The diagnostic performance of non-enhanced CT parameters to detect AAD was calculated.Results:Among the parameters,positive intimal flap,defined as the clear presence of a high-density membrane-like structure in the aorta on serial axial images,had a sensitivity of 54％,a specificity of 100％,a positive predictive value(PPV)of 100％,and a negative predictive value (NPV)of 91％,respectively.The addition of equivocal intimal flap,defined as the ambiguous presence of a high-density membrane-like structure in the aorta on at least one axial image,increased the sensitivity and NPV to 84％ and 87％ respectively.Furthermore,the combination of intimal flap and other parameters,such as the deviation of aortic calcification highdensity area in the aorta,can yield the highest sensitivity of 93％ and the highest NPV of 94％.Conclusion:The combination of non-enhanced CT parameters had a good diagnostic efficiency,which could be an effective diagnostic method for emergency department patients.%目的:探讨平扫CT扫描在急诊疑似主动脉夹层患者中的诊断价值.方法:收集就诊于我院急诊的127例疑似主动脉夹层患者的CT影像(平扫+强化)资料,其中主动脉夹层患者57例,非主动脉夹层患者70例,由2名急诊医师在不知道临床信息及强化CT结果的情况下回顾性分析平扫CT图像,记录诊断准确性.结果:所测参数中,清晰内膜片对主动脉夹层的敏感性、特异性、阳性预测值和阴性预测值分别为54％、100％、100％和73％,清晰内膜片+模糊内膜片对主动脉夹层的诊断敏感性及阴性预测值分别提高至84％和87％.联合钙化内移、主动脉内高密度区等其它征象,则平扫CT可获得最高93％的诊断敏感性及94％的阴性预测值.结论:CT平扫多征象组合对主动脉夹层有较好的诊断价值,是急诊疑似主动脉夹层患者的一种有效诊断方法.
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