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Time-Resolved, Dynamic Computed Tomography Angiography for Characterization of Aortic Endoleaks and Treatment Guidance via 2D-3D Fusion-Imaging
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Computed Tomography Angiography Assessment of Acute Aortic Syndromes: Classification, Differentiating Imaging

Mana Modares1, Kate Hanneman2, Maral Ouzounian3

  • 1Faculty of Medicine, 1 King's College Circle, Medical Sciences Building, 7938University of Toronto, Toronto, Ontario, Canada.

Canadian Association of Radiologists Journal = Journal L'Association Canadienne Des Radiologistes
|April 20, 2021
PubMed

Insights

Acute aortic syndrome (AAS) encompasses conditions like aortic dissection (AD). This review examines current AAS classification systems, highlighting their limitations and discussing imaging features for accurate diagnosis and management.

Area of Science:

  • Radiology
  • Cardiovascular Surgery
  • Vascular Medicine

Background:

  • Acute aortic syndrome (AAS) is a critical condition requiring prompt diagnosis and treatment.
  • Existing classification systems for aortic dissection (AD), such as Stanford and DeBakey, have limitations in describing arch involvement and specific morphologic features.
  • The Society for Vascular Surgery and Society of Thoracic Surgeons (SVS-STS) classification focuses on primary intimomedial tears (PIT) and extent but may not capture all prognostic indicators.

Purpose of the Study:

  • To review and critically analyze existing classification systems for AAS, including AD, acute intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU).
  • To discuss the typical computed tomography angiography (CTA) imaging findings and differentiating features of various AAS entities.
  • To identify common pitfalls in imaging interpretation and outline essential components of a comprehensive CTA report for AAS.

Main Methods:

  • Literature review of current AAS and AD classification systems.
  • Analysis of typical computed tomography angiography (CTA) imaging characteristics of AAS entities.
  • Discussion of limitations in current classification systems and imaging interpretation.

Main Results:

  • Traditional AD classifications (Stanford, DeBakey) lack detail on arch dissections and outcome-predicting features.
  • The SVS-STS classification addresses PIT location and extent but may not encompass all significant morphologic details.
  • CTA is crucial for differentiating AD, IMH, limited intimal tears (LITs), intramural blood pools (IBPs), ulcer-like projections (ULPs), and PAUs.

Conclusions:

  • Current AAS classification systems have limitations that impact diagnosis and management.
  • A comprehensive understanding of CTA imaging features and potential interpretation pitfalls is essential for accurate AAS assessment.
  • Improved reporting of CTA findings can aid in guiding appropriate management strategies for AAS.

Keywords:
aortic dissectioncomputed tomography angiographyintramural hematomalimited dissectionpenetrating atherosclerotic ulcerthoracic endovascular aortic repair

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