Imaging of the aortic root on high-pitch non-gated and ECG-gated CT: awareness is the key!
Prashant Nagpal1, Mukta D Agrawal2,3, Sachin S Saboo4
1Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Insights
Advances in CT technology enable clear imaging of the aortic root without ECG gating. This review helps radiologists identify aortic root pathologies for improved patient outcomes.
Area of Science:
- Radiology
- Cardiovascular Imaging
- Medical Imaging Technology
Background:
- Traditionally, cardiac and proximal aortic imaging required ECG gating, limiting visualization on standard scans.
- Advancements in CT technology, particularly high-pitch scanning, allow for motionless imaging of the chest and abdomen.
- This has led to increased incidental detection of cardiac and aortic root diseases on non-ECG-gated scans.
Purpose of the Study:
- To review the anatomy of the proximal aorta.
- To describe common pathologies of the aortic root and their imaging appearances.
- To enhance radiologists' familiarity with aortic root diseases for earlier diagnosis and intervention.
Main Methods:
- Review of current CT technology advancements, focusing on high-pitch scanning.
- Comprehensive literature review of aortic root pathologies and their characteristic imaging findings.
- Illustrative examples of various aortic root diseases.
Main Results:
- High-pitch CT scans provide motion-artifact-free images with reduced radiation dose.
- These scans increase the visualization of cardiac and aortic root structures.
- Familiarity with a spectrum of aortic root pathologies and their imaging is crucial for diagnosis.
Conclusions:
- Modern CT technology facilitates improved non-ECG-gated imaging of the aortic root.
- Early recognition of aortic root pathologies is essential for timely intervention and better prognosis.
- This review aims to equip radiologists with the knowledge to diagnose these conditions effectively.
Abstract:
The aortic pathologies are well recognized on imaging. However, conventionally cardiac and proximal aortic abnormalities were only seen on dedicated cardiac or aortic studies due to need for ECG gating. Advances in CT technology have allowed motionless imaging of the chest and abdomen, leading to an increased visualization of cardiac and aortic root diseases on non-ECG-gated imaging. The advances are mostly driven by high pitch due to faster gantry rotation and table speed. The high-pitch scans are being increasingly used for variety of clinical indications because the images are free of motion artifact (both breathing and pulsation) as well as decreased radiation dose. Recognition of aortic root pathologies may be challenging due to lack of familiarity of radiologists with disease spectrum and their imaging appearance. It is important to recognize some of these conditions as early diagnosis and intervention is key to improving prognosis. We present a comprehensive review of proximal aortic anatomy, pathologies commonly seen at the aortic root, and their imaging appearances to familiarize radiologists with the diseases of this location.
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