autopsy. The angiographic aspect of the PMCT has been described in centres in England and Europe using different techniques. This study was built on this foundation to develop an alternative approach by adopting interventional techniques under both ultrasound and CT guidance to achieve diagnostic PMCTAs and further preserve the integrity of the body. Methods This prospective study was conducted after the approval of the ethics committee. Sudden adult deaths of unknown cause referred for Coroner's autopsy were recruited. The participants had PMCTA of the coronary arteries with our minimally invasive interventional techniques prior to autopsy (the technique will be described in detail). Results All the ten participants underwent successful PMCTA. The participants' age ranged between 49 to 81 years old and passed away from both coronary and non-coronary related cause of death. Radiologist assessment of coronary artery disease (CAD) on PMCTA versus pathologist autopsy showed 83% concordance (25/30 coronary arteries) with Cohen Kappa coefficient 0.67. CAD severity scores (0 = normal, 1 = mild, 2 = moderate, 3 = severe) between the radiologist and pathologist were non-significant overall (P-value = 0.21), and artery specific (LAD P-value = 0.56; LCx P-value = 0.32; RCA P-value = 0.32). Conclusion This minimally invasive imaging guided technique is able to achieve diagnostic quality PMCTA of the coronary arteries to investigate coronary related cause of death.
Objectives: To assess the diagnostic accuracy and clinical impact of automated artificial intelligence (AI) measurement of thoracic aorta diameter on routine chest CT. Methods: A single-centre retrospective study involving three cohorts. 210 consecutive ECG-gated CT aorta scans (mean age 75 ± 13) underwent automated analysis (AI-Rad Companion Chest CT, Siemens) and were compared to a reference standard of specialist cardiothoracic radiologists for accuracy measuring aortic diameter. A repeated measures analysis tested reporting consistency in a second cohort (29 patients, mean age 61 ± 17) of immediate sequential pre-contrast and contrast CT aorta acquisitions. Potential clinical impact was assessed in a third cohort of 197 routine CT chests (mean age 66 ± 15) to document potential clinical impact. Results: AI analysis produced a full report in 387/436 (89%) and a partial report in 421/436 (97%). Manual vs AI agreement was good to excellent (ICC 0.76–0.92). Repeated measures analysis of expert and AI reports for the ascending aorta were moderate to good (ICC 0.57–0.88). AI diagnostic performance crossed the the threshold for maximally accepted limits of agreement (>5 mm) at the aortic root on ECG-gated CTs. AI newly identified aortic dilatation in 27% of patients on routine thoracic imaging with a specificity of 99% and sensitivity of 77%. Conclusion: AI has good agreement with expert readers at the mid ascending aorta and has high specificity, but low sensitivity, at detecting dilated aortas on non-dedicated chest CTs. Advances in knowledge: An AI tool may improve the detection of previously unknown thoracic aorta dilatation on chest CTs versus current routine reporting.
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