AI-based diagnosis of acute aortic syndrome from noncontrast CT.

Journal: Nature medicine
Published Date: Aug 20, 2025

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.

Authors

  • Yujian Hu
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Yilang Xiang
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Yan-Jie Zhou
  • Yangyan He
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Dehai Lang
    Department of Vascular Surgery, Ningbo No.2 Hospital, Ningbo, China.
  • Shifeng Yang
    Department of Radiology, Shandong Provincial Hospital affiliated to Shandong University, Shandong University, Jinan, Shandong, P.R. China.
  • Xiaolong Du
    Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
  • Chunlan Den
    Department of Radiology, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Youyao Xu
    Department of Vascular Surgery, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, China.
  • Gaofeng Wang
    College of Electrical and Information Engineering, Beihua University, Jilin 132021, China.
  • Zhengyao Ding
    Polytechnic Institute of Zhejiang University, Hangzhou, China.
  • Jingyong Huang
    Department of Vascular Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
  • Wenjun Zhao
    Department of MRI, Xinxiang Central Hospital (The Fourth Clinical College of Xinxiang Medical University), 56 Jinsui Road, Xinxiang, Henan, 453000, China. 594861640@qq.com.
  • Xuejun Wu
    Department of Vascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
  • Donglin Li
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Qianqian Zhu
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Zhenjiang Li
    Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China; Shandong Medical Imaging and Radiotherapy Engineering Center (SMIREC), Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
  • Chenyang Qiu
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Ziheng Wu
    Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China.
  • Yunjun He
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Chen Tian
    School of Metallurgy and Environment, Central South University, Changsha, 410083, China; Chinese National Engineering Research Center for Control & Treatment of Heavy Metal Pollution, Changsha, 410083, China; School of Future Membrane Technology, Fuzhou University, Fuzhou, 350108, China. Electronic address: birdytc@hotmail.com.
  • Yihui Qiu
    Polytechnic Institute of Zhejiang University, Hangzhou, China.
  • Zuodong Lin
    Department of Vascular Surgery, Ningbo No.2 Hospital, Ningbo, China.
  • Xiaolong Zhang
  • Lin Hu
    School of Laboratory Medicine and Life Science, Wenzhou Medical University, Wenzhou 325035, China.
  • Yuan He
    Department of Vascular and Endovascular Surgery, Chinese PLA General Hospital, Beijing, PR China. Electronic address: heyuan@301hospital.com.cn.
  • Zhenpeng Yuan
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Xiaoxiang Zhou
    Department of Vascular Surgery, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
  • Rong Fan
    National Clinical Research Center of Kidney Disease, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
  • Ruihan Chen
    School of Mathematics, China University of Mining and Technology, Xuzhou, 221116, China. Electronic address: crhcumt@163.com.
  • Wenchao Guo
    Hupan Laboratory, Hangzhou, China.
  • Jing Xu
    First Department of Infectious Diseases, The First Affiliated Hospital of China Medical University, Shenyang, China.
  • Jianpeng Zhang
  • Tony C W Mok
  • Zi Li
    Department of Nephrology, Institute of Nephrology, West China Hospital of Sichuan University, Chengdu, China.
  • Mannudeep K Kalra
  • Le Lu
  • Wenbo Xiao
    Department of Neurology, School of Medicine, The Fourth Affiliated Hospital of Zhejiang University, Yiwu, China.
  • Xiaoqiang Li
    Department of Vascular Surgery, Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School, Nanjing, China. Electronic address: SuzhouXQL@163.com.
  • Yun Bian
    Department of Radiology, Changhai Hospital.
  • Chengwei Shao
    Department of Radiology, Changhai Hospital.
  • Guofu Wang
  • Wei Lu
    Department of Pharmacy, Taihe Hospital, Hubei University of Medicine, Shiyan, China.
  • Zhengxing Huang
    College of Biomedical Engineering and Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China.
  • Minfeng Xu
    DAMO Academy, Alibaba Group, Hangzhou 311121, China.
  • Hongkun Zhang
    Department of Vascular Surgery, The First Affiliated Hospital, Zhejiang University, Hangzhou, People's Republic of China.

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