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[Modern diagnostic concepts in dissection and aortic occlusion]
F M Vogt1, M Goyen, J F Debatin
1Zentralinstitut für Röntgendiagnostik, Universitätsklinikum Essen, Hufelandstrasse 55, 45122 Essen. florian.vogt@uni-essen.de
Insights
Non-invasive imaging like CT- and MR-angiography are key for diagnosing aortic dissection and occlusion. Transoesophageal echocardiography offers functional data, while MRA is preferred for patients with kidney issues.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Vascular Medicine
Context:
- Non-invasive imaging techniques have largely replaced invasive angiography for aortic assessment.
- CT-angiography (CTA), MR-angiography (MRA), and sonography are primary tools.
- This review focuses on diagnosing aortic dissection and occlusion.
Purpose:
- To review the diagnostic approaches for aortic dissection and occlusion using cross-sectional imaging.
- To compare the efficacy and specific applications of TEE, CTA, and MRA in evaluating these conditions.
Summary:
- Transoesophageal echocardiography (TEE), CTA, and MRA demonstrate high sensitivity (96-100%) for detecting and classifying aortic dissections (Stanford A and B).
- Each modality offers unique advantages: TEE and MRA excel in assessing aortic valve and coronary artery involvement, while CTA provides detailed morphology.
- For aortic occlusion, CTA and MRA are optimal, offering comprehensive views of morphology, collateral flow, and distal vessels. MRA is recommended for patients with renal impairment.
Impact:
- Provides a comparative overview of advanced imaging modalities for complex aortic diseases.
- Guides clinicians in selecting the most appropriate imaging technique based on the specific aortic pathology and patient factors.
- Highlights the strengths of TEE, CTA, and MRA in characterizing aortic dissections and occlusions, informing treatment decisions.
Abstract:
For the diagnostic work-up of the aorta, non-invasive cross-sectional imaging techniques have almost replaced invasive catheter angiography. CT- and MR-angiography are supplemented by sonography which is used predominantly for the assessment of abdominal aortic aneurysm and dissections of the thoracic aorta. This review deals with the diagnostic approach to two disease entities involving the aorta: aortic dissection and aortic occlusion. Transoesophageal echocardiography (TEE), CT- and MR-angiography (MRA) are used in the assessment of aortic dissection. Published sensitivity and specificity values regarding the detection and classification of dissections into Stanford A and Stanford B range between 96-100% for all three modalities. Results for multislice CTA have not yet been reported, but can be expected to be at least as good. The ability to delineate additional information regarding the precise morphology of true and false lumen, entry and reentry-sites, the development of thrombus or paraaortic hematomas, as well as the assessment of aortic regurgitation or involvement of coronary arteries depend on the chosen technique. Reflecting the ability to collect functional imaging data, both TEE and MRA are superior to CTA in the assessment of aortic valve involvement, while TEE is the modality of choice for evaluation of coronary arteries. Sonography is of limited use in the assessment of abdominal dissections. For the evaluation of patients with suspected aortic occlusion both CTA and MRA represent the imaging modalities of choice. Both provide for a comprehensive and precise depiction of the underlying aortic morphology, the extent of collateral flow as well as delineation of distal run-off vessels. MRA should be employed in patients with impaired renal function as paramagnetic contrast agents are not nephrotoxic.