{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T23:40:20Z","timestamp":1776382820280,"version":"3.51.2"},"reference-count":35,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Chest radiography (CXR) remains the most common first-line imaging for thoracic abnormalities. While aortic knob width can reflect aortic dilation, no standardized, widely recognized thresholds of clinical utility exist. Methods: This pilot retrospective study analyzed 240 emergency department patients (median age 67 years, 61% male) who underwent both PA CXR and chest computed tomography angiography (CTA) within 7 days. Three aortic knob dimensions (horizontal, oblique, vertical) were measured on CXR and compared with CTA measurements at two anatomical levels: proximal to the brachiocephalic trunk (P-BCT) and distal to the left subclavian artery (D-LSA). Results: The horizontal aortic knob width was most closely related to CTA measurements of P-BCT and D-LSA. A regression model incorporating horizontal knob diameter, age, and sex was characterized with an AUC of 0.884 (95% CI 0.825\u20130.944) for detecting aortic dilation (&gt;40 mm). Using a conservative threshold with the upper 95% prediction bound exceeding 40 mm led to 100% sensitivity and 54% specificity, with a negative predictive value of 1.00. Conclusions: Simple quantitative CXR measurements of aortic knob width (horizontal), combined with age and sex, can provide additional confidence for excluding aortic arch dilation. Given further validation in diverse populations, if the high negative predictive value of this approach will be confirmed, it may represent a valuable screening tool to guide decisions for advanced imaging, especially due to low cost and wide availability.<\/jats:p>","DOI":"10.3390\/diagnostics15202564","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T05:48:21Z","timestamp":1760420901000},"page":"2564","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Chest X-Ray as a Screening Tool for Aortic Arch Dilation: CT-Based Evaluation of Reliability"],"prefix":"10.3390","volume":"15","author":[{"given":"Maciej","family":"Lis","sequence":"first","affiliation":[{"name":"Clinical Imaging Diagnostics Center, 5th Military Hospital with Polyclinic in Krakow, 30-901 Krakow, Poland"},{"name":"Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Bany\u015b","sequence":"additional","affiliation":[{"name":"Clinical Imaging Diagnostics Center, 5th Military Hospital with Polyclinic in Krakow, 30-901 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernard","family":"Solewski","sequence":"additional","affiliation":[{"name":"Clinical Imaging Diagnostics Center, 5th Military Hospital with Polyclinic in Krakow, 30-901 Krakow, Poland"},{"name":"Department of Anatomy, Jagiellonian University Medical College, 31-008 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8382-070X","authenticated-orcid":false,"given":"Aleksandra","family":"Stanek","sequence":"additional","affiliation":[{"name":"Clinical Imaging Diagnostics Center, 5th Military Hospital with Polyclinic in Krakow, 30-901 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1608-1418","authenticated-orcid":false,"given":"Maciej","family":"Krupi\u0144ski","sequence":"additional","affiliation":[{"name":"Clinical Imaging Diagnostics Center, 5th Military Hospital with Polyclinic in Krakow, 30-901 Krakow, Poland"},{"name":"Department of Diagnostic Imaging, Faculty of Medicine, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Obuchowicz","sequence":"additional","affiliation":[{"name":"Department of Conservative Dentistry with Endodontics, Jagiellonian University Collegium Medicum, Montelupich 4, 31-155 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7095-7619","authenticated-orcid":false,"given":"Tomasz","family":"Puto","sequence":"additional","affiliation":[{"name":"Clinical Imaging Diagnostics Center, 5th Military Hospital with Polyclinic in Krakow, 30-901 Krakow, Poland"},{"name":"Department of Diagnostic Imaging, Faculty of Medicine, Andrzej Frycz Modrzewski Krakow University, 30-705 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4773-5322","authenticated-orcid":false,"given":"Adam","family":"Pi\u00f3rkowski","sequence":"additional","affiliation":[{"name":"Department of Biocybernetics and Biomedical Engineering, AGH University of Krakow, 30-059 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Krzysztof","family":"Batko","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Allergology, University Hospital, 30-668 Krakow, Poland"},{"name":"Department of Research and Development, Medicine Economy Law Society (MELS) Foundation, 30-040 Krakow, Poland"},{"name":"Doctoral School of Medical and Health Sciences, Jagiellonian University, 30-010 Krakow, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Polanczyk, A., Piechota-Polanczyk, A., Huk, I., Neumayer, C., Balcer, J., and Strzelecki, M. 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