A regression model using horizontal aortic knob diameter on chest radiography, age, and sex detected aortic dilation with an AUC of 0.884 (95% CI 0.825–0.944) and a negative predictive value of 1.00.
Observational (n=240)
Does chest X-ray measurement of aortic knob width reliably detect aortic arch dilation compared to CTA in emergency department patients?
Quantitative CXR measurements of horizontal aortic knob width, combined with age and sex, show high negative predictive value for excluding aortic arch dilation, potentially serving as a cost-effective screening tool.
Effect estimate: AUC 0.884 (95% CI 0.825-0.944)
Background: Chest radiography (CXR) remains the most common first-line imaging for thoracic abnormalities. While aortic knob width can reflect aortic dilation, no standardized, widely recognized thresholds of clinical utility exist. Methods: This pilot retrospective study analyzed 240 emergency department patients (median age 67 years, 61% male) who underwent both PA CXR and chest computed tomography angiography (CTA) within 7 days. Three aortic knob dimensions (horizontal, oblique, vertical) were measured on CXR and compared with CTA measurements at two anatomical levels: proximal to the brachiocephalic trunk (P-BCT) and distal to the left subclavian artery (D-LSA). Results: The horizontal aortic knob width was most closely related to CTA measurements of P-BCT and D-LSA. A regression model incorporating horizontal knob diameter, age, and sex was characterized with an AUC of 0.884 (95% CI 0.825–0.944) for detecting aortic dilation (>40 mm). Using a conservative threshold with the upper 95% prediction bound exceeding 40 mm led to 100% sensitivity and 54% specificity, with a negative predictive value of 1.00. Conclusions: Simple quantitative CXR measurements of aortic knob width (horizontal), combined with age and sex, can provide additional confidence for excluding aortic arch dilation. Given further validation in diverse populations, if the high negative predictive value of this approach will be confirmed, it may represent a valuable screening tool to guide decisions for advanced imaging, especially due to low cost and wide availability.
Lis et al. (Sat,) conducted a observational in Aortic arch dilation (n=240). Chest radiography (CXR) aortic knob width measurement vs. Chest computed tomography angiography (CTA) was evaluated on Detection of aortic dilation (>40 mm) (AUC 0.884, 95% CI 0.825-0.944). A regression model using horizontal aortic knob diameter on chest radiography, age, and sex detected aortic dilation with an AUC of 0.884 (95% CI 0.825–0.944) and a negative predictive value of 1.00.