Purpose
To describe and evaluate the main features of acute aortic dissection (AAD) on computed tomography angiography (CTA).
To describe the role of CTA in post-surgical follow-up.
To emphasize the added value of ECG-gated CTA in the evaluation of Stanford A aortic dissection
Methods and Materials
Background
Definition and Classification
Acute aortic dissection (AAD) is part of a complex similar pathologies defined as Acute Aortic Syndrome, the other two being intra-mural hematoma (IMH) and penetrating atherosclerotic ulcer (PAU).
Aortic dissection is defined as a pathologic process that allows bloods to enter in the media due to an intimal tear or a rupture of tunica media’s vasa vasorum. Subsequently, this process leads to the formation of a true lumen (TL) and a false lumen (FL) that communicate through at least an intimal...
Results
We evaluated 20 patients who underwent various surgery procedures after they were diagnosed with Stanford A AAD.
All the exams were acquired at baseline without ECG triggering. As a consequence, while macroscopic features like the presence of TL and FL or the involvement of other vessels originating from the aorta could be easily detectable, it’s been challenging to clearly assess the presence of an intimal tear. Therefore, we managed to evaluate the presence and thus measure an entry intimal tear only in 5 patients (25%)....
Conclusion
CTA has a pivotal role concerning diagnosis and therapeutical management in patients affected by Stanford A AAD, because it is a technique characterized by high sensitivity and specificity just like Cardiac MRI or TOE, but with the advantage of being also available almost everywhere and really quick to perform.
The added value of ECG-gating mainly consists in a great reduction of motion artifacts that could possibly lead to misinterpretation of CT images. Furthermore, it is also really useful in post-operative evaluation of prosthetic aorta and...
References
Ueda T, Fleischmann D, Rubin GD, Dake MD et al., Imaging of the Thoracic Aorta Before and After Stent-Graft Repair of Aneurysms and Dissections. Semin Thorac Cardiovasc Surg. 2008 Winter;20(4):348-357
Meyersohn NM, Ghemigian K, Shapiro MD et al., Role of Computed Tomography in Assessment of the Thoracic Aorta. Curr Treat Options Cardiovasc Med. 2015 Aug;17(8):395.
Valente T, Rossi G, Lassandro F et al., MDCT evaluation of acute aortic syndrome (AAS). Br J Radiol 2016; 89:20150825.
Erbel R, Aboyans V, Boileau C et al., Guidelines on...