Noninvasive Imaging of the Thoracic Aorta

Thoracic aortic disease is a common problem affecting the geriatric population of the U.S. Thoracic aortic aneurysms and aortic dissection and its variants are the most common diseases of the thoracic aorta, often leading to death if not treated immediately. Contrast aortography is no longer considered to be the diagnostic gold standard for evaluating the thoracic aorta. This is a review of those abnormalities most commonly seen in the geriatric population: thoracic aortic aneurysms, aortic dissections, intramural hematomas, and penetrating ulcers. The roles of multiplanar transesophageal echocardiography (TEE), spiral computed tomography (CT), and magnetic resonance imaging (MRI) are discussed in the evaluation of each of these disease entities. Although each has been shown to have high sensitivities and specificities for the diagnosis of aneurysms and dissections and its variants, TEE and MRI are thought to be superior to spiral CT because of their ability to evaluate the aortic valve apparatus. However, spiral CT is perhaps the easiest and most cost effective modality to screen patients with known or suspected aortic dissection. (c)1999 by CVRR, Inc.