Abstract
Objective
To explore and compare the diagnostic value of color Doppler ultrasound and CT for abdominal aortic dissection aneurysm.
Methods
A retrospective analysis was conducted on the data of 104 patients with suspected abdominal aortic dissection aneurysm treated in our hospital from May 2018 to May 2020. Using symptoms, signs, and aortography results as the diagnostic gold standard, we analyzed the diagnostic agreement rates of color Doppler ultrasound and CT, and compared the diagnostic efficacy of the two methods (sensitivity, specificity, positive predictive value, negative predictive value).
Results
The diagnostic agreement rate of color Doppler ultrasound was higher than that of CT, and the number of aortic rupture sites, the number of affected branch vessels, the formation of intramural thrombus, and arterial wall calcification were also higher than those found by CT, with statistically significant differences (P < 0.05). Additionally, the sensitivity, specificity, positive predictive value, and negative predictive value of color Doppler ultrasound were higher than those of CT, with statistically significant differences (P < 0.05). Finally, the incidence of adverse reactions in the color Doppler ultrasound group was lower than that in the CT group (P = 0.031).
Conclusion
Color Doppler ultrasound is more effective in the clinical diagnosis of patients with abdominal aortic dissection aneurysm, which is beneficial for improving disease detection rates, and is superior to CT with lower adverse reactions. It is worthy of clinical recommendation.
Keywords: Abdominal aortic dissection aneurysm, Color doppler ultrasound, CT scan, Diagnostic efficacy
Acute abdominal aortic dissection refers to the tearing of the aortic intima, allowing blood to flow between the layers of the aortic wall, forming a dissection [1]– [2]. According to the latest epidemiological studies, the incidence of acute abdominal aortic dissection is rising annually in China, particularly among middle-aged and elderly men, where this trend is especially pronounced.Globally, among individuals aged 65 and above, the condition affects 4–8% of males, compared to only 1–2% of females [3]– [4]. Statistics from the Chinese Cardiovascular Disease Center indicate that approximately tens of thousands of patients are hospitalized each year due to acute aortic dissection, reflecting the high prevalence of this disease and revealing its profound impact on families and society [5]. Furthermore, the mortality rate increases by 1–2% per hour after the onset of acute abdominal aortic dissection, with a mortality rate of about 20% within 24 h and reaching 50% within one week; thus, early intervention, patient screening, and timely surgical treatment are effective measures to improve the survival rate of such patients [6].
Imaging examinations are one of the preferred methods for diagnosing acute abdominal aortic dissection. Among various imaging modalities, computed tomography (CT scan), with its high resolution and rapid imaging characteristics, has become the commonly used initial examination in clinical practice [7]. CT scans can clearly display the anatomical structure of the aorta, quickly identify the presence and extent of the dissection, and assist doctors in formulating targeted treatment plans. However, despite the high sensitivity and specificity of CT scans in diagnosing acute aortic dissection, the longer examination time, radiation exposure, potential harm to critically ill patients, and risks associated with contrast agents can adversely affect patients [8]. In contrast, color Doppler ultrasound can effectively compensate for these shortcomings, and studies have shown that the efficacy of color Doppler examination for abdominal aortic aneurysms is higher than that of CT scans, although there is less research on its application in acute aortic dissection [9]. Based on this, this article aims to analyze the diagnostic efficacy of color Doppler and CT scans in acute aortic dissection, with the intention of providing a theoretical basis for improving the diagnostic level of acute aortic dissection.
General information and methods
General information
A retrospective analysis was conducted on the data of104 patients with suspected abdominal aortic dissection aneurysm treated at our hospital from May 2018 to May 2020. The diagnosis was based on symptoms, signs, and the results of aortography as the gold standard. The compliance rates of color Doppler ultrasound and CT examination were analyzed, and the diagnostic efficacy (sensitivity, specificity, positive predictive value, and negative predictive value) of the two methods was compared.
Inclusion and exclusion criteria
Inclusion criteria
This study specifically investigates localized abdominal aortic dissection aneurysms. All enrolled patients had a primary entry tear originating in the abdominal aorta, with the dissection limited to the abdominal segment. Patients with abdominal aortic dissection secondary to the extension of a Stanford type A or type B thoracic dissection were excluded.
1. Patients aged > 18 years; 2.The reference standard for final diagnosis was the combination of intraoperative findings and intraoperative aortography [10]; 3.Patients were deemed ‘hemodynamically stable’ upon admission, defined as a systolic blood pressure > 90 mmHg without the need for vasopressor support, and the absence of signs of organ malperfusion (e.g., limb ischemia, visceral ischemia, or neurological deficit; 4. Patients with normal cognitive function; 5.Localized abdominal aortic dissection aneurysms 0.5.Patients with DeBakey type II dissections were included only in the presence of a concomitant, separate abdominal aortic pathology that qualified for the study’s primary endpoint.Exclusion criteria: (1) Patients with penetrating atherosclerotic ulcers (PAU) and intramural hematomas (IMH) ; (2) Patients with liver and kidney dysfunction; (3) Patients with loss of consciousness; (4) Patients with concurrent tumors; (5) Patients with a history of abdominal aortic surgery; (6) Patients with concurrent hematological diseases; (7) Patients with severe infections; (8) Patients with coagulation disorders;9.Secondary extension from a Stanford A or DeBakey I/III thoracic dissection. This study was approved by the ethics committee of our hospital.
Examination methods
CT Examination: Preparation before scanning included fasting for 4 h prior to the examination (to reduce intestinal artifacts), using non-ionic iodine contrast agents (such as Iohexol, Iopamidol), with a typical dose of 80–100 mL (flow rate 3–5 mL/s); renal function was assessed, and eGFR was calculated (≥ 30 mL/min can be used safely, hydration if necessary), and the patient’s history of iodine allergy was inquired, with pre-treatment (hormones + antihistamines) if necessary. Scanning parameters: the range from the diaphragm to the bifurcation of the femoral artery (covering the iliac arteries), thickness ≤ 1 mm (thin-layer reconstruction), using standard + high resolution (bone algorithm for assessing calcification) for reconstruction, tube voltage selected at 100–120 kV (140 kV may be used for obese patients). (3) Scanning phases: Plain scan: assessing calcification, mural thrombus, and integrity of the aneurysm wall; Arterial phase: showing the aneurysm lumen, rupture, and involvement of branch vessels, 25–30 s (contrast agent tracking trigger); Venous phase: assessing thrombus and leakage (e.g., after EVAR), 60–70 s. Color Doppler Examination Method The instrument used was a color Doppler ultrasound detector, produced by General Electric, model LOGIQ E9. The probe frequency was set according to individual patient differences, typically L12.3 MHz or C5.2 MHz. During the examination, the patient was placed in a supine position, with the examination site fully exposed, starting longitudinal examination from the thoracic aorta until the common iliac arteries were examined. Ultrasound was used to observe the intravascular diameter dissection and separation, as well as the blood flow status between the true lumen and false lumen, checking for the presence of thrombus and clarifying the relationship between the abdominal aorta and other arteries. Observation Indicators Color Doppler diagnostic criteria: AAA diagnostic criteria: local dilation ≥ 3.0 cm or exceeding 1.5 times the normal segment; observing the morphology of the aneurysm, such as fusiform (symmetrical) or saccular (eccentric); mural thrombus appears as low echo or mixed echo; integrity of the aneurysm wall, whether there are local thinning or rupture signs (peripheral hematoma), etc. Blood flow and thrombus status at the intimal entry; analyzing the thickness of the abdominal dissection, thrombus size, separation length, lumen diameter, and analyzing the carotid arteries, celiac artery, renal arteries, bilateral iliac arteries, and superior mesenteric artery. CT scan results: measuring the maximum diameter of fluid in the abdominal aorta, AAA diagnostic criteria: ≥3 cm (or exceeding 1.5 times the normal segment), mural thrombus, showing iso/slightly high density on plain scan, no enhancement after contrast, calcification showing high density on plain scan, indicating arteriosclerosis. Compliance Rate of Diagnosis: Using symptoms, signs, and aortography results as the gold standard for diagnosis, comparing the compliance rates, sensitivity, specificity, positive predictive value, and negative predictive value of the two methods for diagnosing abdominal aortic aneurysm [11].
Data statistical
Data analysis was performed using SPSS 26.0 software. Measurement data were expressed as Mean ± SEM, and t-tests (normal distribution) were used for the analysis of measurement data, with independent samples t-tests for intergroup comparisons. For non-normal distribution, rank-sum tests (Mann-Whitney U) were used. Count data were expressed as rates (percentages), and Chi-square tests were used for the analysis of count data, with P < 0.05 indicating statistical significance.
Results
General Information of the Patients in This Group A total of 76 patients were included in this group, among which 50 were male and 26 were female. Other baseline data are detailed in Table 1.
Table 1.
Baseline data of patients in this group
| Variable | Statistical value |
|---|---|
| Age(yr) | 68.5 ± 5.8 |
| Gender(M/F) | 80/24 |
| BMI(kg/m2) | 26.5 ± 3.2 |
| Course of illness (days) | 5.4 ± 2.2 |
| Hypertension | 70 |
| Diabetes | 15 |
| Hyperlipidemia | 41 |
| Smoking history | 39 |
| COPD | 14 |
COPD: chronic obstructive pulmonary disease; Yr: year; BMI: Body mass index; M:male; F:female
Peripheral blood markers of patients in this group at admission
The results of this study show that inflammatory markers in patients with abdominal aortic aneurysm are higher than normal levels, while other indicators show no abnormal findings. See Table 2.
Table 2.
Peripheral blood indicators of this group of patients
| Variable | Statistical value |
|---|---|
| WBC | 12.3 ± 2.8 × 109 |
| IL-6(ng/ml) | 15.4 ± 2.1 |
| CRP(ng/ml) | 36.8 ± 7.1 |
| AST(U/L) | 35.6 ± 3.2 |
| ALT(U/L) | 31.5 ± 2.9 |
| Creatinine(ummol/L) | 85.3 ± 2.2 |
WBC: white blood count; IL-6:Interleukin-6;CRP: C-Reactive Protein; AST: Aspartate Aminotransferase;ALT: Alanine Aminotransferase
Comparison of the compliance rates of two methods for diagnosing abdominal aortic aneurysm
The results of this study indicate that the compliance rate of color Doppler ultrasound in diagnosing abdominal aortic aneurysm is higher than that of CT scan; at the same time, it outperforms CT scan in terms of the number of aortic rupture sites, cumulative number of vascular branches, formation of intramural thrombus, and arterial wall calcification, as detailed in Tables 3 and 4.
Table 3.
Comparison of diagnostic situations of two examination methods
| Aortic dissection classification | Color Doppler Ultrasound Examination | CT scan examination | χ2/P-vaule |
|---|---|---|---|
| DeBaKey classification I | 20 | 18 | 0.150/0.700 |
| II | 32 | 20 | 4.664/0.031 |
| III | 10 | 6 | 1.143/0.285 |
| Diagnostic Concordance Rate | 62/64 | 44/64 | - |
| P-value | 0.034 | - | |
CT: Computed Tomography
Table 4.
Comparison of other performances between two examination methods
| Group | Number of aortic tears | Involved vascular branches | Intramural thrombosis | Arterial wall calcification |
|---|---|---|---|---|
| Color Doppler Ultrasound Examination | 2.11 ± 0.45 | 5.28 ± 0.83 | 30 | 8 |
| CT scan examination | 1.60 ± 0.34 | 4.02 ± 0.57 | 16 | 1 |
| P-value | 0.002 | <0.001 | 0.015 | 0.033 |
CT: Computed Tomography
Diagnostic efficacy of two examination methods
The results of this study indicate that the sensitivity, specificity, positive predictive value, and negative predictive value of color Doppler ultrasound examination are superior to those of CT scanning, with statistically significant differences. Please refer to Tables 5 and 6 for details.
Table 5.
Results of two inspection methods
| Inspection Method | Gold standard | Total | |
|---|---|---|---|
| Positive | Negative | ||
| Color Doppler Ultrasound Examination Positive | 62 | 4 | 66 |
| Negative | 2 | 36 | 38 |
| CT scan examination Positive | 44 | 18 | 62 |
| Negative | 20 | 22 | 42 |
| Total | 64 | 40 | 104 |
Table 6.
Comparison of diagnostic efficacy of two examination methods
| Inspection Method | Sensitivity | Specificity | Positive predictive value | Negative Predictive Value |
|---|---|---|---|---|
| Color Doppler Ultrasound Examination | 62/64 | 36/40 | 62/66 | 36/38 |
| CT scan examination | 44/64 | 22/40 | 44/62 | 22/42 |
| P-value | 0.004 | 0.002 | 0.020 | <0.001 |
Two diagnostic methods ROC curve
The results of this study show that the AUC of color Doppler examination for diagnosing aortic dissection is greater than that of CT scan. See Fig. 1; Table 7 for details.
Fig. 1.
ROC curve of two diagnostic methods; A: Color Doppler examination of acute aortic dissection ROC curve; B: CT scan examination of acute aortic dissection ROC curve
Table 7.
ROC comparison of two diagnostic methods
| Inspection Method | AUC | 95%CI |
|---|---|---|
| Color Doppler Ultrasound Examination | 0.726 | 0.656 ~ 0.796 |
| CT scan examination | 0.705 | 0.636 ~ 0.773 |
Signs of two examination methods
The results of this study show that color Doppler imaging reveals varying degrees of dilation in the ascending aorta, with evidence of tearing within the arterial lumen. The aorta is divided into true and false lumens, with a double-ring sign observed in cross-section and a double-lumen appearance in longitudinal section; there is significant tearing of the intima, with one end of the intima directly connected to the arterial wall, while the other end appears free, fluttering with the heartbeat. Color Doppler ultrasound blood flow imaging shows that the blood flow within the true lumen is bright and has a relatively fast flow velocity; the blood flow in the false lumen is relatively dull and flows slowly. During systole, blood flow from the true lumen can directly enter the false lumen at the site of rupture, and during diastole, a backflow phenomenon occurs, as shown in Figs. 2A-B. CT imaging shows dilation of the ascending aorta and contrast agent extravasation, but it cannot dynamically observe blood flow direction and accompanying cardiac cycles, as shown in Figs. 3A-B.
Fig. 2.
Classic images of aortic dissection from color Doppler examination
Fig. 3.
Classic images of aortic dissection from CT examination
Comparison of adverse reactions between two examination methods
The results of this study indicate that the incidence of adverse reactions in color Doppler examination is lower than that in CT scan, and the difference is statistically significant (P = 0.028). See Table 8 for details.
Table 8.
Comparison of adverse reaction incidence between the two groups of patients
| Inspection Method | Nausea | Vomiting | Shortness of breath | Hypotension |
|---|---|---|---|---|
| Color Doppler Ultrasound Examination | 1 | 1 | 0 | 0 |
| CT scan examination | 3 | 1 | 3 | 2 |
| χ² | 4.802 | |||
| P-value | 0.028 | |||
Discussion
Abdominal aortic dissection aneurysm, a complex and critical condition, has gradually attracted widespread attention in the medical community. As a potentially fatal disease, early diagnosis and treatment of abdominal aortic dissection aneurysm are crucial [12, 13]. Clinicians often rely on conventional CT scans when examining patients with abdominal aortic dissection aneurysm. While this method provides preliminary diagnostic information to some extent, its limitations cannot be ignored. First, the sensitivity and specificity of conventional CT scans for lesions are relatively low, making it difficult to accurately assess the severity of the disease [14]. Although patients receive certain imaging results after this examination, the specific progression of the disease remains unclear [15]. More seriously, treatment plans based on uncertain results may lead to clinical treatment failures and even cause irreversible safety incidents, posing a significant threat to the patient’s life.
Based on this, exploring other more effective examination methods to improve the diagnostic accuracy of abdominal aortic dissection aneurysm has important clinical significance. Recent studies have shown that color Doppler ultrasound is increasingly valuable in clinical applications, as it can identify diseases early and provide more accurate judgments regarding the occurrence and progression of the condition, thereby allowing more time for clinical treatment [16, 17]. Therefore, exploring the clinical practicality of color Doppler examination for aortic dissection is of great significance. The results of this study indicate that the compliance rate, diagnostic efficacy, and ROC of color Doppler examination for acute aortic dissection are higher than those of CT scans, which may be related to the following mechanisms: color Doppler ultrasound is a technique that uses the principle of sound waves to detect blood flow, capable of displaying the speed and direction of blood flow in real-time. This technology converts reflected sound waves into visual images, allowing medical personnel to intuitively observe blood flow in the vessels and thus assess the health status of the vessels. Compared to traditional black-and-white ultrasound, color Doppler not only improves image clarity but also enhances the ability to analyze blood flow dynamics, particularly excelling in the diagnosis of cardiovascular diseases. Aortic dissection, as a serious cardiovascular disease, is complex and progresses rapidly, often leading to severe consequences, even threatening life [18, 19]. Aortic dissection refers to the tearing of the aortic intima, where blood forms a dissection between the inner and outer layers of the arterial wall. As the dissection expands, it may lead to aortic rupture, causing fatal hemorrhage. Therefore, rapid and accurate diagnosis is crucial for patient survival. Although CT scans, as a widely used imaging examination method, can provide clear images in many cases, their sensitivity and specificity in diagnosing aortic dissection are limited, mainly due to the fact that imaging manifestations are often influenced by various factors, such as the patient’s body type, the size and location of the dissection, and its relationship with surrounding structures, all of which can directly affect imaging results [20]. For example, in obese patients, due to the interference of adipose tissue, CT images may become blurred, leading to unclear boundaries of the dissection and subsequently affecting the physician’s judgment. Finally, the rapid progression of the dissection aneurysm may also cause imaging examinations to fail to timely reflect changes in the condition, resulting in missed or misdiagnoses, similar conclusions have been drawn in previous studies [21, 22]. Additionally, color Doppler ultrasound can also assess cardiac function, clarify cardiac structure, and evaluate conditions such as pericardial effusion and obstruction, thus improving the accuracy of diagnosing abdominal aortic dissection aneurysm and enhancing the consistency rate of diagnoses [23, 24]. The results demonstrate that color Doppler ultrasound exhibits superior diagnostic performance over contrast-enhanced CT in detecting abdominal aortic dissection, with significantly higher sensitivity, specificity, positive predictive value, and negative predictive value. This enhanced efficacy may be attributed to a combination of technical, physiological, and operator-related advantages. Technically, the real-time, dynamic capability of Doppler imaging enables continuous visualization of the intimal flap and flow dynamics throughout the cardiac cycle, potentially revealing subtle tears or communications that might be missed on single-phase CT acquisition. Additionally, ultrasound avoids limitations associated with ionizing radiation and iodinated contrast, such as suboptimal contrast timing or beam-hardening artifacts from vertebral bodies, which can obscure dissection membranes on CT. Physiologically, the high temporal resolution of ultrasound reduces susceptibility to motion artifacts from cardiac pulsation or respiration, while transducer pressure can displace overlying bowel gas in certain patients, improving the acoustic window in a manner not feasible with CT. These factors collectively enhance the diagnostic efficiency of color Doppler ultrasound, corroborating findings from prior studies [25].
When comparing the complication rates of the two groups of patients, the results showed that the complication occurrence in the color Doppler examination group was lower than that in the CT scan group, mainly for the following reasons: color Doppler examination does not require a special environment, whereas CT must be performed in a relatively enclosed space, which may cause some patients to experience discomfort such as difficulty breathing and circulatory fluctuations, similar to previous scholarly research findings [26,27].
In summary, the compliance rate, efficacy, and ROC of color Doppler examination for acute aortic dissection are superior to those of CT scans, and the complication rate is lower than that of CT scans, indicating important clinical practicality and warranting clinical recommendation for use. However, this study still has certain limitations. First, the sample size is relatively small and it is a single-center study, necessitating further multicenter large-sample studies to enhance the research conclusions.Secondly, this study demonstrates that color Doppler ultrasound exhibits high diagnostic efficacy in a selected, stable patient population. However, it is crucial to emphasize that computed tomography angiography (CTA) remains the undisputed first-line modality for the initial diagnosis, confirmation, and anatomical classification of aortic dissection, particularly in acute or complex presentations where its comprehensive visualization is irreplaceable. The value of color Doppler ultrasound in this context lies in its utility as a complementary tool in stable outpatients, for routine surveillance of known pathology, or as a rapid bedside assessment in situations where CTA is not immediately available, which was not the scenario in our present study.At last, a key limitation of this study is the operator-dependent nature of color Doppler ultrasound. The high diagnostic performance was achieved by experienced sonographers in a specialized vascular center, which may limit the generalizability of our findings to non-specialized settings with less expertise.
Author contributions
Chenhongliang and Duan jia qing wrote the main manuscript text and prepared figures . All authors reviewed the manuscript.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Data availability
No datasets were generated or analysed during the current study.
Declarations
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
No datasets were generated or analysed during the current study.