Superior mediastinal cut-off measurements in chest radiographs for the screening of silent thoracic aortic diseases

Kantheera  Leesmidt; Boonyarit  Sintuvikaiwong; Apichaya  Sripariwuth

Authors

Kantheera Leesmidt Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
Boonyarit Sintuvikaiwong Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
Apichaya Sripariwuth Faculty of Medicine, Naresuan University, Phitsanulok, Thailand

Keywords:

Chest radiograph, cut-off values, mediastinal measurement, nontraumatic aortic disease, widening of mediastinum

Abstract

Background: Analyzing the diagnostic cut-off values of chest radiographs provides an in-depth understanding of unrecognized aortic diseases, thereby contributing to a more comprehensive approach to identifying subtle aortic abnormalities.

Objectives: The objective of this study was to determine the cut-off measurements for superior mediastinal width and mediastinal width-to-thoracic cage ratio from chest radiographs for the early detection of unrecognized thoracic aortic diseases. In addition, this study aimed to enhance diagnostic strategies for identifying aortic abnormalities.

Methods: This retrospective analysis included 152 patients who underwent computed tomography angiography (CTA) of the thoracic aorta and chest radiograph between April 2007 and January 2021. Superior mediastinal width was measured at three levels on chest radiographs. Thoracic CTA findings were categorized into normal and abnormal groups, the latter comprising aortic dissection, intramural hematoma, penetrating atherosclerotic ulcer, and aneurysm. The cut-off values for the superior mediastinal width and mediastinal width-to-thoracic cage ratio were calculated using receiver operating characteristic (ROC) curve analysis.

Results: The optimal cut-off values were a mediastinal width ≥8.4 cm at the aortic knob level (ROC 77.3, 95% confidence interval (CI) 69.8–84.9, P < 0.001; sensitivity 72.7%, specificity 71.1%, positive predictive value (PPV) 58.8%, negative predictive value (NPV) 82.1%) and a mediastinal width-to-thoracic cage ratio ≥ 0.294 at the same level (ROC 78.6, 95% CI 70.8–86.3, P < 0.001; sensitivity 80.0%, specificity 61.9%, PPV 54.3%, NPV 84.5%).

Conclusion: The established superior mediastinal width and ratio cut-off values from chest radiographs can aid clinicians in identifying patients who are at risk for silent thoracic aortic disease, prompting further CTA evaluation that can prevent fatal outcomes and improve patients’ quality of life.

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