AI System Diagnoses Acute Aortic Syndrome From Non-Contrast CT, Cutting Time to Diagnosis by 70%
The iAorta AI warning system, developed for acute aortic syndrome detection on non-contrast CT, achieved AUC 0.958 in a multicenter retrospective study of 20,750 scans and maintained high sensitivity (0.91-0.94) and specificity (0.99) across 137,525 real-world scans. In a prospective comparative study, the system reduced the time to correct diagnostic pathway from a mean of 220 minutes to 62 minutes. In emergency department pilot deployment, iAorta correctly identified 21 of 22 AAS cases among 15,584 consecutive patients.
The original study
AI-based diagnosis of acute aortic syndrome from noncontrast CT.
- Authors
- Hu Y, Xiang Y, Zhou YJ, He Y, Lang D, Yang S, et al.
- Journal
- Nature medicine
- Type
- Journal Article, Multicenter Study
- PMID
- 40835970
Original abstract
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) min to 61.6 (43-89) min. Furthermore, for the prospective pilot deployment that we conducted, iAorta correctly identified 21 out of 22 patients with AAS among 15,584 consecutive patients presenting with acute chest pain and under noncontrast CT protocol in the emergency department. For these 21 AAS-positive patients, the average time to diagnosis was 102.1 (75-133) min. Finally, iAorta may help prevent delayed or missed diagnoses of AAS in settings where noncontrast CT remains the only feasible initial imaging modality-such as in resource-limited regions or in patients who cannot receive, or did not receive, intravenous contrast.