[New imaging technics in dissection of the thoracic aorta]

The multiplicity of imaging for investigation of the thoracic aorta requires that the physician choose a strategy adapted to the disorder involved: this is the case, for example with dissection of the aorta. A critical study of the new methods available which include digital angiography; echocardiography; CT scan; magnetic resonance imaging (MRI), should be compared to "the" reference technique of conventional methods: aortography and two-dimensional cineangiography. In addition, the decision must take into account specific characteristics of the disorder: natural history of the disease and anatomopathological form which are useful for the surgeon in case surgery is decided upon. The strategy proposed remains faithful to two-dimensional cineangiography during the first 72 hours of acute dissection because this disorder is a true surgical emergency at this stage if the ascending aorta is involved. Later, or if the ascending aorta does not appear to be involved, MRI has now proven this efficacy as a first-line diagnostic procedure. The judiciousness of preoperative aortography is still the subject of debate.