MR angiography can guide ED management of suspected acute aortic dissection

Area of Science:

• Emergency Medicine
• Radiology
• Cardiovascular Imaging

Background:

• Aortic dissection diagnosis typically relies on computed tomography angiography (CTA).
• The utility of magnetic resonance angiography (MRA) in the emergency department (ED) for this condition remains under investigation.
• This study assesses MRA's role in evaluating suspected acute thoracic aortic dissection within the ED setting.

Purpose of the Study:

• To determine the feasibility and outcomes of using MRA for acute thoracic aortic dissection evaluation in the ED.
• To identify patient populations and indications for MRA in this context.
• To analyze MRA's impact on patient management and disposition from the ED.

Main Methods:

• A retrospective review of patients undergoing MRA for suspected acute thoracic aortic dissection in the ED between January 2010 and June 2016.
• Analysis of patient demographics, clinical presentation, contraindications to CTA, MRA outcomes, and ED disposition.
• Evaluation of diagnostic quality and completion rates of MRA examinations.

Main Results:

• Fifty MRAs were performed, primarily due to iodinated contrast allergy (42%) or renal insufficiency (42%).
• The median time from ED arrival to MRA completion was 311 minutes.
• Of 49 completed MRAs, 42 were diagnostic, with 2 positive for acute dissection and 47 negative. 18 patients were discharged home.
• MRA demonstrated a 4% rate of acute dissection detection, guiding management and enabling safe discharge for some patients.

Conclusions:

• Magnetic resonance angiography (MRA) is a viable alternative to CTA for evaluating acute thoracic aortic dissection in the ED, particularly for patients with contraindications.
• MRA can provide diagnostic information to guide management decisions and facilitate safe patient discharge.
• The study supports the role of MRA in specific ED scenarios for suspected aortic dissection.