Problems and pitfalls in the evaluation of thoracic aortic dissection by computed tomography

Area of Science:

• Radiology
• Medical Imaging
• Cardiovascular Disease

Background:

• Computed tomography (CT) with contrast is a primary tool for diagnosing aortic dissection.
• Accurate diagnosis is critical for timely and appropriate patient management.
• Potential imaging pitfalls can compromise diagnostic accuracy.

Purpose of the Study:

• To identify and describe common conditions that cause false positive or false negative diagnoses of aortic dissection using CT.
• To enhance the understanding of imaging artifacts and anatomical variations that mimic or obscure aortic dissection.

Main Methods:

• Review of CT imaging findings in patients with suspected aortic dissection.
• Analysis of specific imaging characteristics associated with misdiagnosis.
• Comparison of CT findings with other imaging modalities where applicable.

Main Results:

• Insufficient contrast enhancement can lead to missed intimal flaps, resulting in false negative diagnoses.
• Extraaortic structures (e.g., mediastinal veins, pericardium) can be misinterpreted as dissection flaps (false positives).
• CT artifacts, such as streak artifacts and superimposition in thick slices, can mimic dissection features. Fusiform aneurysms with thrombus present diagnostic challenges.

Conclusions:

• Several factors can lead to inaccurate CT diagnoses of aortic dissection.
• Awareness of these potential pitfalls is essential for radiologists to avoid misdiagnosis.
• Improved interpretation techniques and understanding of artifacts can improve diagnostic accuracy for aortic dissection.