AI-based diagnosis of acute aortic syndrome from noncontrast CT

作者：Yujian Hu, Yilang Xiang, Yan-Jie Zhou, Yangyan He, Dehai Lang, Shifeng Yang, Xiaolong Du, Chunlan Den, Youyao Xu, Gaofeng Wang, Gaofeng Wang, Zhengyao Ding, Jingyong Huang, Wen-Jun Zhao, Xuejun Wu, Donglin Li, Qianqian Zhu, Zhenjiang Li, Chenyang Qiu, Ziheng Wu, Tian Chen, Chen Tian, Yihui Qiu, Zuodong Lin, Xiaolong Zhang, Lin Hu, Zhenpeng Yuan, Zhenpeng Yuan, Xiaoxiang Zhou, Rong Fan, Ruihan Chen, Wenchao Guo, Jing Xu, Jianpeng Zhang, Tony C. W. Mok, Zi Li, Mannudeep K. Kalra, Le Lü, Wenbo Xiao, Xiaoqiang Li, Yun Bian, Chengwei Shao, Guofu Wang, Guofu Wang, Wei Lu, Zhengxing Huang, Mengwei Xu, Hongkun Zhang · 发表于：Nature Medicine · 年份：2025 · DOI：10.1038/s41591-025-03916-z · 被引用次数：18 · 研究领域：Aortic Disease and Treatment Approaches、Aortic aneurysm repair treatments、Cardiac Imaging and Diagnostics

The accurate and timely diagnosis of acute aortic syndrome (AAS) in patients presenting with acute chest pain remains a clinical challenge. Aortic computed tomography (CT) angiography is the imaging protocol of choice in patients with suspected AAS. However, due to economic and workflow constraints in China, the majority of suspected patients initially undergo noncontrast CT as the initial imaging testing, and CT angiography is reserved for those at higher risk. Although noncontrast CT can reveal specific signs indicative of AAS, its diagnostic efficacy when used alone has not been well characterized. Here we present an artificial intelligence-based warning system, iAorta, using noncontrast CT for AAS identification in China, which demonstrates remarkably high accuracy and provides clinicians with interpretable warnings. iAorta was evaluated through a comprehensive step-wise study. In the multicenter retrospective study (n = 20,750), iAorta achieved a mean area under the receiver operating curve of 0.958 (95% confidence interval 0.950-0.967). In the large-scale real-world study (n = 137,525), iAorta demonstrated consistently high performance across various noncontrast CT protocols, achieving a sensitivity of 0.913-0.942 and a specificity of 0.991-0.993. In the prospective comparative study (n = 13,846), iAorta demonstrated the capability to significantly shorten the time to correct diagnostic pathway for patients with initial false suspicion from an average of 219.7 (115-325)...