Dynamic Imaging Features of Retrospective Cardiac Gating CT Angiography Influence Delayed Adverse Events in Acute Uncomplicated Type B Aortic Dissections

Area of Science:

• Cardiovascular Imaging
• Thoracic Surgery
• Medical Diagnostics

Background:

• Uncomplicated type B acute aortic dissection (uTB-AAD) requires accurate risk stratification.
• Delayed adverse events (DAE) in uTB-AAD can lead to poor outcomes.
• Predictive markers for DAE in uTB-AAD are crucial for timely intervention.

Purpose of the Study:

• To explore the association between dynamic morphological parameters from cardiac gating CT angiography (CTA) and DAE in uTB-AAD patients.
• To identify specific CTA-derived metrics that predict DAE.
• To evaluate the efficacy of dynamic CTA features over static imaging for DAE detection.

Main Methods:

• Retrospective review of 87 uTB-AAD patients.
• Analysis of dynamic CTA variables: minimum relative true lumen diameter (RTLAmin), ratio of minimum to maximum true lumen relative area (r-RTLA), descending aorta diameter, false lumen diameter, and primary entry tear size.
• Outcome assessment included DAE and early mortality (3-14 days).

Main Results:

• 29.9% of patients experienced DAE.
• Smaller RTLAmin and r-RTLA (at upper thoracic descending aorta and renal artery levels) correlated with higher DAE incidence.
• Larger descending aorta diameter, false lumen diameter, and entry tear size were associated with DAE.
• r-RTLA at the upper thoracic descending aorta showed high diagnostic accuracy (82.0%) for DAE detection (AUC=0.839).
• Dynamic CTA features outperformed static imaging in predicting DAE (P<0.001).

Conclusions:

• Dynamic morphological parameters from cardiac gating CTA are valuable for identifying uTB-AAD patients at high risk for DAE.
• These findings can inform early, targeted interventions to improve patient outcomes.
• Dynamic CTA analysis offers superior predictive capability compared to single-phase imaging.