Retrospective Comparative Analysis of Computed Tomography Findings of Acute and Chronic Aortic Dissections and
Dexter Mendoza1, Silanath Terpenning2, Sejal Verma3
1Department of Radiology, Massachusetts General Hospital, Boston, MA.
Insights
Ancillary computed tomography angiography (CTA) findings for acute aortic dissection (AD) and intramural hematoma (IMH) are often present in chronic cases. These imaging markers, including flap thickness, are not reliable indicators of the acuity of AD or IMH.
Area of Science:
- Cardiovascular Imaging
- Thoracic Radiology
- Vascular Imaging
Background:
- Distinguishing acute from chronic aortic dissection (AD) and intramural hematoma (IMH) is crucial for patient management.
- Computed tomography angiography (CTA) is a primary imaging modality for diagnosing AD and IMH.
- Certain ancillary findings on CTA have been traditionally associated with acute AD and IMH.
Purpose of the Study:
- To evaluate the reliability of ancillary imaging findings in differentiating acute from chronic AD and IMH using CTA.
- To determine if traditional indicators of acute AD and IMH are consistently present in chronic cases.
Main Methods:
- Two experienced cardiothoracic and vascular radiologists reviewed paired CTAs from patients with AD or IMH.
- CTAs were obtained in both acute (within 24 hours) and chronic settings, with radiologists blinded to the temporal order.
- Measurements of minimum and maximum flap thickness and the presence of pleural effusion, pericardial effusion, mediastinal hematoma/fat stranding, and lymphadenopathy were recorded.
Main Results:
- No statistically significant differences were found in mean minimum flap thickness (1.3 mm vs. 1.4 mm, P=0.3) or mean maximum flap thickness (2.7 mm vs. 2.9 mm, P=0.29) between acute and chronic AD.
- Incidences of ancillary findings such as pleural effusion (55% vs. 37%, P=0.143) and periaortic fat stranding (87% vs. 76%, P=0.344) did not significantly differ between acute and chronic AD.
- The prevalence of pericardial effusion and lymphadenopathy was similar in both acute and chronic settings (P=1.0 for both).
Conclusions:
- Traditional ancillary CT imaging findings for acute AD and IMH are frequently observed in chronic cases.
- These ancillary findings are not reliable indicators for determining the acuity of AD or IMH.
- Flap thickness on CTA may not be a dependable imaging biomarker for the acuity of aortic dissection.
Purpose:
The objective of this study was to assess the reliability of ancillary imaging findings in distinguishing acute from chronic aortic dissection (AD) and intramural hematoma (IMH) using computed tomography angiography (CTA).
Materials And Methods:
Two radiologists specializing in cardiothoracic and vascular imaging reviewed paired CTAs of patients with AD or IMH who underwent CTA in the acute (within 24 h of presentation) and chronic settings. The radiologists were blinded to the temporal order of the CTAs. Minimum and maximum flap thicknesses and presence or absence of pleural effusion, pericardial effusion, mediastinal hematoma or fat standing, and mediastinal lymphadenopathy were recorded.
Results:
Patients included 25 male individuals and 13 female individuals with a mean age of 59 years (range: 34 to 87 y). The group included 29 AD and 9 IMH cases. The median interval between the paired CTs was 542 days (range: 100 to 2533 d). Respectively, the mean minimum flap thicknesses in the acute and chronic AD were 1.3 and 1.4 mm (P=0.3), and the mean maximum flap thicknesses were 2.7 and 2.9 mm (P=0.29). The incidences of ancillary findings in acute and chronic AD and IMH were as follows: pleural effusion (55% vs. 37%, P=0.143), pericardial effusion (8% vs. 11%, P=1.0), lymphadenopathy (47% vs. 47%, P=1.0), and periaortic fat stranding (87% vs. 76%, P=0.344).
Conclusions:
Ancillary CT imaging findings traditionally ascribed to acute AD and IMH are also often found in the chronic setting and are not reliable indicators of acuity. Flap thickness in AD may not be a reliable imaging indicator of acuity of AD.
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