Radiologic evaluation of aortic dissection

The radiologic assessment of patients suspected of having an aortic dissection must be based on an understanding of the treatment options and how these are to be employed in any clinical setting. The appropriate selection and timing of imaging studies is crucial. The diagnosis of dissection must be quickly confirmed, other diseases that mimic dissection must be excluded, and the type and extent of dissection must be established so that appropriate therapy can be instituted. Although computed tomography, magnetic resonance (MR) imaging, and echocardiography greatly enhanced the ability to evaluate the aorta by noninvasive means, aortography remains the examination of choice for defining the vascular anatomy, especially when surgical intervention is considered. MR imaging may become the primary examination for the initial and subsequent evaluation of acute and chronic dissections as MR angiographic techniques improve and changes are made in monitoring equipment to allow the safe examination of acutely ill patients.