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Diagnostic imaging of aortic atherosclerosis and its complications
1Department of Radiology, New York University Medical Center, 530 First Avenue, New York, NY 10016, USA. Glenn.Krinsky@med.nyu.edu
Insights
Transesophageal echocardiography (TEE) is currently preferred for imaging thoracic aortic atherosclerosis. Advances in MRI and CT promise more detailed, less invasive evaluations in the future for this condition.
Area of Science:
- Cardiovascular Imaging
- Atherosclerosis Research
- Medical Diagnostics
Background:
- Thoracic aortic atherosclerosis is a significant contributor to patient morbidity and mortality.
- Current imaging modalities have limitations in performance, information detail, and availability.
Purpose of the Study:
- To review the current state of imaging for thoracic aortic atherosclerosis.
- To explore the potential of emerging technologies for improved evaluation.
Main Methods:
- Transesophageal echocardiography (TEE) is the current standard of care.
- Computed tomography (CT) and magnetic resonance imaging (MRI) are discussed as evolving alternatives.
- Gadolinium-enhanced 3D MR angiography (3DMRA) is highlighted for specific applications.
Main Results:
- TEE offers a balance of performance, information, and availability for imaging thoracic aortic atherosclerosis.
- CT and MRI show promise for less invasive and more comprehensive assessments, particularly with plaque characterization and contrast agents.
- Gadolinium-enhanced 3DMRA excels in noninvasive detection of plaque in proximal aortic arch vessels.
- CT and MRI are superior for evaluating penetrating atherosclerotic ulcers and associated complications like intramural hematoma, pseudoaneurysm, and rupture.
Conclusions:
- While TEE remains the current choice, advancements in CT and MRI are expected to enhance the noninvasive evaluation of thoracic aortic atherosclerosis.
- Future imaging techniques may offer superior plaque characterization and a more complete understanding of the disease and its complications.
Abstract:
Thoracic aortic atherosclerosis has been shown to be an important cause of severe morbidity and mortality. At the present time, the case of performance, detailed information obtainable, and availability make TEE the procedure of choice for the imaging of thoracic aortic atherosclerosis; however, further technical advances in MR and CT, particularly in MR plaque characterization and the use of plaque specific contrast agents, may allow for a less invasive and more complete evaluation of thoracic aortic atherosclerosis in the near future. Gadolinium-enhanced 3DMRA is the procedure of choice for the noninvasive detection of plaque in the proximal aortic arch vessels. Furthermore, both CT and MRI are better suited to evaluate penetrating atherosclerotic ulcers and their complications such as intramural hematoma, pseudoaneurysm formation, and aortic rupture.