High Rate of False Negative Diagnosis of Silent Patent Ductus Arteriosus on the Chest CT with 3 mm Slice-Thickness, Suggesting the Need for Analysis with Thinner Slice Thickness

Abstract

The purpose of this study was to evaluate the diagnostic accuracy of patent with ductus arteriosus (PDA) based on the availability of pretest information on routine chest CT with 3 mm slice-thickness. We retrospectively evaluated CT of 64 patients with PDA. The enrolled patients were categorized as group 1 (presence of pretest information) and 2 (absence of pretest information, silent PDA). CTs were read by eleven board-certified radiologists, and subsequently by two blind readers. We investigated whether a PDA was mentioned on the initial CT reading. Correct diagnosis of PDA was made in all patients with group 1 (n = 42). In contrast, only 13.7% were correctly diagnosed in group 2. All cases of missed PDA in group 2 were also missed by two blind readers. It is important to realize that the diagnostic accuracy of silent PDA is poor on the chest CT with 3 mm slice-thickness. Thus, use of axial CT images with the thinnest slice-thickness and multi-planar reformatted images (i.e., sagittal and coronal images) may be one way to reduce the number of missed PDA.

The Patent Ductus Arteriosus in Adults with Special Focus on Role of CT

“…An elongated PDA has a similar configuration to type A, but with a much more elongated appearance, and is often identified in infants. The subtypes of PDA of the angiographic classification can be used analogously on chest CT ( Figure 2 ) [ 9 ].…”

“…Earlier detection of small size PDA is important because it may lead to earlier intervention (i.e., percutaneous closure of PDA with occluder device). Despite the importance of identification of incidental PDA on CT, a high false negative diagnosis rate has been reported for silent PDAs study [ 9 ]. In a recent study, the diagnostic accuracy of silent PDA on CT was poor.…”

“…This result was attributed mainly to the small size of the PDAs and their anatomic location (i.e., a small structure between the aorta and main pulmonary artery demonstrating strong enhancement). To avoid a false negative diagnosis, the authors recommended analysis of axial CT images with thinner slice thickness (1–2 mm) and the use of multiplanar reformatted images such as coronal and sagittal views for better evaluation of small PDAs [ 9 ].…”