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Pitfalls in diagnosis of aortic dissection by angiography: algorithmic approach utilizing CT and MRI
H L Mast1, D H Gordon, A M Kantor
1Department of Radiology, State University of New York, Brooklyn 11203.
Insights
Diagnosing thoracic aortic dissection, a critical condition, involves imaging to locate tears. A proposed algorithm aids surgeons in selecting the best imaging method based on patient factors and preferences.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Diagnostic Radiology
Background:
- Aortic dissection is a life-threatening condition requiring precise imaging for diagnosis.
- Traditional angiography, while a gold standard, has limitations in visualizing dissections.
- Computed tomography (CT) and magnetic resonance imaging (MRI) offer high accuracy but have specific constraints.
Observation:
- Angiography may fail due to lumen overlap or thin intimal flaps.
- CT accuracy is 95% but can be hindered by technical issues or thrombosed lumens.
- MRI necessitates patient stability and cooperation.
Findings:
- A diagnostic algorithm is proposed to guide the selection of imaging modalities for aortic dissection.
- The algorithm considers patient renal function and surgeon preference.
Implications:
- This approach aims to optimize the diagnostic process for thoracic aortic dissection.
- It may improve timely and accurate diagnosis, leading to better patient outcomes.
- The algorithm provides a structured framework for clinical decision-making in complex cases.
Abstract:
Dissection of the thoracic aorta is a life-threatening event requiring imaging studies to define the level of the tear and the intimal flap. The "gold standard" has been angiography. This method may fail to demonstrate the dissection, however, due to overlap of the true and false lumens or a very thin flap that is imaged en face rather than tangentially. Computed tomography has a diagnostic accuracy of 95%, but can fail to image the dissection due to technical factors or a thrombosed false lumen. Magnetic resonance imaging requires a hemodynamically stable and cooperative patient. A diagnostic algorithm is proposed for diagnosis of aortic dissection based on renal function and the surgeon's imaging modality preference.