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Updated: Sep 1, 2025

Three-Dimensional Imaging of Aortic Tissues in Atherosclerosis
Published on: October 25, 2024
Imaging of Genetic Thoracic Aortopathy
Kacie L Steinbrecher1, Kaitlin M Marquis1, Alan C Braverman1
1From the Mallinckrodt Institute of Radiology (K.L.S., K.M.M., S.B., C.A.R.), Department of Internal Medicine, Cardiovascular Division (A.C.B.), Department of Surgery (J.W.O.), and Department of Pathology (C.Y.L.), Washington University School of Medicine, 510 S Kingshighway Blvd, St Louis, MO 63110; and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (M.N.).
Insights
Genetic aortopathy increases the risk of aortic events. Early identification by radiologists is crucial for timely intervention and tailored surgical repair in patients with heritable thoracic aortic disease (HTAD).
Area of Science:
- Genetics and Radiology
- Cardiovascular Imaging
- Thoracic Aortic Disease
Background:
- Aortopathy encompasses genetic diseases leading to increased risk of aortic events like aneurysm and acute aortic syndrome.
- Heritable thoracic aortic disease (HTAD) is subclassified into syndromic and nonsyndromic forms, with syndromic HTAD presenting specific phenotypic features.
- Radiologists are often the first to detect signs of genetic aortopathy, necessitating awareness of its implications.
Purpose of the Study:
- To highlight the importance of radiologist recognition of genetic aortopathy.
- To emphasize the distinct management and surgical intervention thresholds for genetic aortopathy compared to non-genetic forms.
- To underscore the need for familiarity with differential diagnoses, including acquired thoracic aortic diseases.
Main Methods:
- Review of imaging and phenotypic features associated with various types of genetic aortopathy.
- Comparison of diagnostic challenges and management strategies for genetic versus non-genetic aortopathy.
- Emphasis on a multidisciplinary approach integrating imaging for diagnosis and lifelong follow-up.
Main Results:
- Genetic aortopathy requires lower aortic diameter thresholds for surgical intervention.
- Surgical approaches and extent may differ in patients with genetic aortopathy.
- Overlapping imaging and phenotypic features can complicate diagnosis and follow-up recommendations.
Conclusions:
- Radiologists play a critical role in the early identification of genetic aortopathy.
- Accurate diagnosis and understanding of genetic aortopathy are essential for appropriate clinical management and surgical planning.
- Lifelong imaging surveillance is crucial for patients diagnosed with genetic aortopathy.
Abstract:
Aortopathy is a term most commonly used to describe a group of genetic diseases that predispose patients to an elevated risk of aortic events including aneurysm and acute aortic syndrome. Types of genetic aortopathy are classified as either heritable or congenital, with heritable thoracic aortic disease (HTAD) further subclassified into syndromic HTAD or nonsyndromic HTAD, the former of which is associated with specific phenotypic features. Radiologists may be the first physicians to encounter features of genetic aortopathy, either incidentally or at the time of an acute aortic event. Identifying patients with genetic aortopathy is of substantial importance to clinicians who manage thoracic aortic disease, because aortic diameter thresholds for surgical intervention are often lower than those for nongenetic aortopathy related to aging and hypertension. In addition, when reparative surgery is performed, the approach and extent of the repair may differ in patients with genetic aortopathy. The radiologist should also be familiar with competing diagnoses that can result in acute aortic events, mainly acquired inflammatory and noninflammatory thoracic aortic disease, because these conditions may be associated with increased risks of similar pathologic endpoints. Because many imaging and phenotypic features of various types of genetic aortopathy overlap, diagnosis and determination of appropriate follow-up recommendations can be challenging. A multidisciplinary approach with the use of imaging is often required and, once the diagnosis is made, imaging has additional importance because of the need for lifelong follow-up. ©RSNA, 2022.
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