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Yan Q, Hu G, Wang Q, Wu L, Zhang J, He L, Jiao C, Ma S, Xiong M. Clinical application of pulse-gated non-enhanced rapid magnetic resonance imaging in the definitive diagnosis of aortic dissection. Clinics (Sao Paulo) 2024; 79:100467. [PMID: 39216122 PMCID: PMC11402381 DOI: 10.1016/j.clinsp.2024.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/12/2024] [Accepted: 07/17/2024] [Indexed: 09/04/2024] Open
Abstract
OBJECTIVE Aortic Dissection (AD) is one of the most fatal acute diseases in cardiovascular diseases, with rapid onset and progression and a high fatality rate. This study aims to investigate the clinical values of non-enhancement peripheral pulse-gating rapid magnetic resonance imaging in deterministic diagnosis of AD. METHODS Aorta magnetic resonance imaging was performed in 21 healthy volunteers at a 1.5t MR scanner sequences including cardiac-gated and peripheral pulse-gated True-FISP and HASTE were carried out separately. Acquisition Time (TA), Signal to Noise Ratio (SNR), Contrast Noise Ratio (CNR), and entirety of vessel wall blood flow artifacts were measured and compared. A total of 56 AD cases were displayed by non-enhancement peripheral pulse-gating fast MR imaging, and the results were compared with pathological findings or CTA of the aorta. The dissection rupture, tear film, true and false lumen, thrombosis, hydropericardium, and the main branches of AD were evaluated respectively. RESULTS There were no significant differences in SNR, CNR, entirety of the vessel wall, and blood flow artifact between cardiac-gated and peripheral pulse-gated fast MR imaging. Non-enhancement pulse-gated fast scanning takes less TA time. By the pulse-gated non-enhancement fast MR imaging, the dissection rupture, tear film, true and false cavity, thrombosis, hydropericardium, and the main branches of aortic dissection were shown clearly. Multi-planar and multi-angle scans helped to show the extent of entrapment rupture, whereas partial complex tears or bi-directional tears were slightly less well visualized. CONCLUSION Non-enhancement peripheral pulse-gated rapid magnetic resonance imaging can be used for deterministic diagnosis of AD.
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Affiliation(s)
- QinWen Yan
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China
| | - Gang Hu
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China
| | - Qin Wang
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China
| | - Lei Wu
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China
| | - Jun Zhang
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China
| | - Lan He
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China
| | - CiLai Jiao
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China
| | - Si Ma
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China
| | - MinChao Xiong
- Department of Medical Imaging (Radiology), Ezhou Central Hospital Affiliated to Hubei University of Science and Technology, Ezhou City, Hubei Province, PR China.
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Contrella BN, Khaja MS, Majdalany BS, Kim CY, Kalva SP, Beck AW, Browne WF, Clough RE, Ferencik M, Fleischman F, Gunn AJ, Hickey SM, Kandathil A, Kim KM, Monroe EJ, Ochoa Chaar CI, Scheidt MJ, Smolock AR, Steenburg SD, Waite K, Pinchot JW, Steigner ML. ACR Appropriateness Criteria® Thoracoabdominal Aortic Aneurysm or Dissection: Treatment Planning and Follow-Up. J Am Coll Radiol 2023; 20:S265-S284. [PMID: 37236748 DOI: 10.1016/j.jacr.2023.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
As the incidence of thoracoabdominal aortic pathology (aneurysm and dissection) rises and the complexity of endovascular and surgical treatment options increases, imaging follow-up of patients remains crucial. Patients with thoracoabdominal aortic pathology without intervention should be monitored carefully for changes in aortic size or morphology that could portend rupture or other complication. Patients who are post endovascular or open surgical aortic repair should undergo follow-up imaging to evaluate for complications, endoleak, or recurrent pathology. Considering the quality of diagnostic data, CT angiography and MR angiography are the preferred imaging modalities for follow-up of thoracoabdominal aortic pathology for most patients. The extent of thoracoabdominal aortic pathology and its potential complications involve multiple regions of the body requiring imaging of the chest, abdomen, and pelvis in most patients. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Bill S Majdalany
- Panel Chair, University of Vermont Medical Center, Burlington, Vermont
| | - Charles Y Kim
- Panel Chair, Duke University Medical Center, Durham, North Carolina
| | - Sanjeeva P Kalva
- Panel Vice-Chair, Massachusetts General Hospital, Boston, Massachusetts
| | - Adam W Beck
- University of Alabama at Birmingham Medical Center, Birmingham, Alabama; Society for Vascular Surgery
| | | | - Rachel E Clough
- St Thomas' Hospital, King's College, School of Biomedical Engineering and Imaging Science, London, United Kingdom; Society for Cardiovascular Magnetic Resonance
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; Society of Cardiovascular Computed Tomography
| | - Fernando Fleischman
- Keck School of Medicine of USC, Los Angeles, California; American Association for Thoracic Surgery
| | - Andrew J Gunn
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Sean M Hickey
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; American College of Emergency Physicians
| | - Asha Kandathil
- UT Southwestern Medical Center, Dallas, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - Karen M Kim
- University of Michigan, Ann Arbor, Michigan; The Society of Thoracic Surgeons
| | | | | | | | - Amanda R Smolock
- Froedtert & The Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Scott D Steenburg
- Indiana University School of Medicine and Indiana University Health, Indianapolis, Indiana; Committee on Emergency Radiology-GSER
| | - Kathleen Waite
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | - Jason W Pinchot
- Specialty Chair, University of Wisconsin, Madison, Wisconsin
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Rajiah PS, Weber N, Loewen J, Kasten H, Williamson E, Moore A, Leng S. Dynamic CT Angiography in Vascular Imaging: Principles and Applications. Radiographics 2022; 42:E224-E225. [PMID: 36178805 DOI: 10.1148/rg.210177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Prabhakar Shantha Rajiah
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., N.W., J.L., H.K., E.W., S.L.); and Department of Radiology, Baylor University Medical Center, Dallas, Tex (A.M.)
| | - Nikkole Weber
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., N.W., J.L., H.K., E.W., S.L.); and Department of Radiology, Baylor University Medical Center, Dallas, Tex (A.M.)
| | - Jennifer Loewen
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., N.W., J.L., H.K., E.W., S.L.); and Department of Radiology, Baylor University Medical Center, Dallas, Tex (A.M.)
| | - Holly Kasten
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., N.W., J.L., H.K., E.W., S.L.); and Department of Radiology, Baylor University Medical Center, Dallas, Tex (A.M.)
| | - Eric Williamson
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., N.W., J.L., H.K., E.W., S.L.); and Department of Radiology, Baylor University Medical Center, Dallas, Tex (A.M.)
| | - Alastair Moore
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., N.W., J.L., H.K., E.W., S.L.); and Department of Radiology, Baylor University Medical Center, Dallas, Tex (A.M.)
| | - Shuai Leng
- From the Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 559905 (P.S.R., N.W., J.L., H.K., E.W., S.L.); and Department of Radiology, Baylor University Medical Center, Dallas, Tex (A.M.)
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van Bakel PAJ, Henry M, Kim KM, Yang B, van Herwaarden JA, Alberto Figueroa C, Patel HJ, Williams DM, Burris NS. Imaging features of renal malperfusion in aortic dissection. Eur J Cardiothorac Surg 2022; 61:805-813. [PMID: 35019977 PMCID: PMC8947793 DOI: 10.1093/ejcts/ezab555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/08/2021] [Accepted: 11/20/2021] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Malperfusion syndrome accompanying aortic dissection is an independent predictor of death with in-hospital mortality rates >60%. Asymmetrically decreased renal enhancement on computed tomography angiography is often considered evidence of renal malperfusion. We investigated the associations between renal enhancement, baseline laboratory values and the diagnosis of renal malperfusion, as defined by invasive manometry, among patients with aortic dissection. METHODS In this retrospective cohort study, we included all patients who were referred to our institution with acute dissection and suspected visceral malperfusion between 2010 and 2020. We determined asymmetric renal enhancement by visual assessment and quantitative density measurements of the renal cortex. We collected invasive renal artery pressures during invasive angiography at the aortic root and in the renal arteries. Logistic regression was performed to evaluate independent predictors of renal malperfusion. RESULTS Among the 161 patients analysed, the majority of patients were male (78%) and had type A dissection (52%). Invasive angiography confirmed suspected renal malperfusion in 83% of patients. Global asymmetric renal enhancement was seen in 42% of patients who did not have renal malperfusion during invasive angiography. Asymmetrically decreased renal enhancement was 65% sensitive and 58% specific for renal malperfusion. Both global [odds ratio (OR) 4.43; 1.20-16.41, P = 0.03] and focal (OR 11.23; 1.12-112.90, P = 0.04) enhancement defects were independent predictors for renal malperfusion. CONCLUSIONS In patients with aortic dissection, we found that differential enhancement of the kidney as seen on the computed tomography angiography is predictive, but not prescriptive for renal malperfusion. While detection of renal malperfusion is aided by computed tomography angiography, its diagnosis requires close monitoring and often invasive assessment.
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Affiliation(s)
| | | | - Karen M Kim
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Bo Yang
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - C Alberto Figueroa
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | - Nicholas S Burris
- Corresponding author. Department of Radiology, University of Michigan, 1500 E Medical Center Drive, CVC 5588, SPC 5030, Ann Arbor, MI 48109, USA. Tel: +1-734-768-7169; e-mail: (N.S. Burris)
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Basha MAA, Salem AF, Azmy TM, Shehata SM. The added value of CT virtual angioscopy to MDCT angiography in the evaluation of aortic diseases. Abdom Radiol (NY) 2020; 45:2576-2584. [PMID: 32564211 DOI: 10.1007/s00261-020-02607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Incorporation of virtual angioscopy (VA) in the diagnostic work-up of aortic diseases could improve the clinical value and efficiency of multidetector computed tomography angiography (MDCTA). We aim to evaluate the clinical usefulness of virtual aortic navigation by CT angiography in various aortic diseases as a complement to standard MDCTA. MATERIALS AND METHODS We retrospectively selected 211 patients who performed MDCTA for suspected or operated aortic diseases. VA endoluminal images of the aorta were obtained by a fly-through technique. Two senior vascular radiologists independently evaluated all MDCTA images. After 1 month, the same two radiologists independently reviewed the MDCTA images combined with CTVA images. The respective accuracy of CTVA in delineating aortic abnormalities was compared to that of MDCTA using Fisher's exact test. The Fleiss kappa (κ) statistic was used to assess the inter-reader agreement (IRA). RESULTS We detected 229 abnormalities in 203 patients on MDCTA and 231 abnormalities in 205 patients on CTVA. CTVA provided significant additional findings in 63.8% (146/229) of all abnormalities diagnosed by MDCTA (p < 0.001, odd ratio [OR] = 42). Although CTVA diagnosed two abnormalities overlooked by MDCTA, the value was statistically insignificant (p = 0.787, OR = 1.3). Regarding postoperative abnormalities, the CTVA added significant additional findings over MDCTA (p = 0.006, OR = 87.4). The overall IRA for the performance of CTVA was good (κ = 0.699). CONCLUSIONS CTVA yields extra findings and improves diagnostic efficiency of MDCTA, especially in postoperative patients.
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Abstract
Computed tomography angiography (CTA) has become a mainstay for the imaging of vascular diseases, because of high accuracy, availability, and rapid turnaround time. High-quality CTA images can now be routinely obtained with high isotropic spatial resolution and temporal resolution. Advances in CTA have focused on improving the image quality, increasing the acquisition speed, eliminating artifacts, and reducing the doses of radiation and iodinated contrast media. Dual-energy computed tomography provides material composition capabilities that can be used for characterizing lesions, optimizing contrast, decreasing artifact, and reducing radiation dose. Deep learning techniques can be used for classification, segmentation, quantification, and image enhancement.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55904, USA.
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Zhao S, Gu H, Duan Y, Cheng Z, Chen B, Yang S, Wang X. Impact of the Intima Dynamic Motion in Type B Acute Aortic Dissection on Renal Injury: Quantificationally Assessed by Dose-Regulated Retrospective ECG-Gated Dual-Source CT Angiography. Acad Radiol 2019; 26:1320-1327. [PMID: 30658929 DOI: 10.1016/j.acra.2018.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about the influence of intima dynamic motion on organ ischemia and related outcomes. The purpose of this study is to quantitatively evaluate intima oscillation by CT angiography (CTA), determine its impact on acute kidney injury (AKI) in patients with type B acute aortic dissection (TB-AAD) before thoracic endovascular aortic repair (TEVAR), and further analyze its association with early adverse events postoperatively. METHODS Totally, 108 patients with TB-AAD who underwent retrospective ECG-gated CTA and received TEVAR were enrolled. Patients were divided into AKI and non-AKI groups. Area of the true lumen (TLA) was computed at R-R intervals at the upper level of kidney vessel origin every 5% step from 0% to 95%. Additionally, other morphologic parameters that have been identified as risk predictors for adverse events in uncomplicated TB-AAD were evaluated. RESULTS Forty-three (39.8%) patients were sorted into the AKI group. Patients with AKI exhibited a larger value for the relative change of TLA (Crel-TLA) than patients in the non-AKI group (p < 0.001), as well as a larger maximum diameter of the descending aorta (p = 0.023) and the primary entry tear (p = 0.012). Crel-TLA and elevated systolic blood pressure were independent predictors of AKI. Patients with Crel-TLA ≥ 42.6% were associated with a high incidence of renal ischemia before TEVAR and early adverse events postoperatively (all p < 0.001). CONCLUSION Intima dynamic motion, as quantitatively evaluated by CTA, has a significant influence on renal injury before and after the aortic intervention, as well as other adverse events, which might guide clinical therapy in high-risk patients.
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Affiliation(s)
- Shuo Zhao
- Department of Radiology, Shandong Provincial Hospital, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China
| | - Hui Gu
- Department of Radiology, Shandong Provincial Hospital, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China
| | - Yanhua Duan
- Shandong Medical Imaging Research Institute, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, Jinan, Shandong, PR China
| | - Zhaoping Cheng
- Shandong Medical Imaging Research Institute, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, Jinan, Shandong, PR China
| | - Baojin Chen
- Department of Radiology, Shandong Provincial Hospital, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China
| | - Shifeng Yang
- Department of Radiology, Shandong Provincial Hospital, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Disease, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China.
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Saremi F, Hassani C, Lin LM, Lee C, Wilcox AG, Fleischman F, Cunningham MJ. Image Predictors of Treatment Outcome after Thoracic Aortic Dissection Repair. Radiographics 2018; 38:1949-1972. [DOI: 10.1148/rg.2018180025] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Farhood Saremi
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Cameron Hassani
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Leah M. Lin
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Christopher Lee
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Alison G. Wilcox
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Fernando Fleischman
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
| | - Mark J. Cunningham
- From the Departments of Radiology (F.S., C.H., L.M.L., C.L., A.G.W.) and Cardiovascular Surgery (C.H., F.F., M.J.C.), University of Southern California, USC University Hospital, 1500 San Pablo St, Los Angeles, CA 90033
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Abstract
Acute pathology in the abdominal aorta is associated with significant morbidity and mortality. The most feared complication of abdominal aortic disease is acute rupture in the setting of atherosclerotic abdominal aortic aneurysm. Although frank rupture often is easily diagnosed on CT, other findings such as a hyperattenuating crescent, discontinuous intimal calcium, and draping of the aorta are subtle signs of aneurysm instability. A true aneurysm should be distinguished from a rapidly growing, saccular pseudoaneurysm in the setting of infectious aortitis, as treatment strategy differs. Acute aortic syndrome involving the abdominal aorta, such as dissection and intramural hematoma, often is an extension of thoracic aortic disease, whereas penetrating atherosclerotic ulcers occasionally involve only the abdominal aorta. The goal of treating acute aortic pathology is to repair and prevent rupture, as well as restore and maintain perfusion of the lower extremities, kidneys, and mesentery. However, both open and endovascular repair of the abdominal aorta may become acutely complicated, resulting in compromise of these goals. Examples include aortoenteric fistula, endoleak, anastomotic pseudoaneurysm, graft infection, and thrombosis or kinking of a stent graft resulting in ischemia of the limbs and mesentery.
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Affiliation(s)
- William Curtis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA.
| | - Motoyo Yano
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA
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Urbanski PP, Sodah A, Matveeva A, Irimie V, Wagner M, Agaev A, Schmitt R. Importance of accurately locating the entry site for endovascular treatment of retrograde Type A acute aortic dissection. Interact Cardiovasc Thorac Surg 2018; 26:731-737. [DOI: 10.1093/icvts/ivx399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/01/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Paul P Urbanski
- Department of Cardiovascular Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
| | - Ayman Sodah
- Department of Cardiovascular Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
| | - Anna Matveeva
- Department of Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
| | - Vadim Irimie
- Department of Cardiovascular Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
| | - Matthias Wagner
- Department of Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
| | - Arzou Agaev
- Department of Vascular Surgery, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
| | - Rainer Schmitt
- Department of Radiology, Cardiovascular Center Bad Neustadt, Bad Neustadt, Germany
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Lu CY, Diao YK, Guo YQ, Zhang XH, Bai HL, Li ZL. Can multiphase dynamic CT angiography provide a better assessment of aortic dissection compared with the standard triphasic protocol? Acta Radiol 2018; 59:58-64. [PMID: 28440669 DOI: 10.1177/0284185117704236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Acute aortic dissection (AD) is a life-threatening medical emergency. It has been debated whether the multiphase dynamic computed tomography angiography (CTA) protocol is superior to the standard triphasic protocol for revealing the characteristics of AD. Purpose To examine two multiphase dynamic protocols, Dynamic four-dimensional (4D) CTA using the shuttle mode and Flash 4D CTA using the high-pitch mode for the assessment of AD and to compare them with the standard triphasic protocol. Material and Methods A total of 54 consecutive patients were randomly and equally assigned to three groups and scanned with a second-generation DSCT scanner. Groups A, B, and C were assessed with the Dynamic 4D CTA in the shuttle mode, the Flash 4D CTA in the high-pitch mode, and the standard triphasic acquisition protocol, respectively. Image quality of all patients was evaluated. The effective radiation dose (ED) was recorded. Results In 54 patients, CTA images could display the true and false lumens, the intimal flap, the entry tear, and branch vessel involvement in the AD. Compared with group C, additional diagnostic information was obtained in groups A and B, including the dynamic enhancement delay between the true and false lumens (A = 18, B = 18); the presence of membrane oscillation (A = 8, B = 14); dynamic ejection of the contrast material from the true lumen into the false lumen (A = 6, B = 7); and the dynamic obstruction of the left renal artery (B = 2). The ED in these three groups was significantly different ( P < 0.05). Conclusion Compared to the standard triphasic protocol, the multiphase dynamic CTA protocol is feasible and is able to reveal additional diagnostic information. Therefore, we recommend using the high-pitch, dual-source multiphase dynamic CTA to assess ADs.
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Affiliation(s)
- Chun-yan Lu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yi-ke Diao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Ying-qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiao-hui Zhang
- Department of Healthcare Imaging & Therapy Division, Siemens Ltd. China, Nanhui, Shanghai, PR China
| | - Hong-li Bai
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Zhen-lin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Geropapas G, Galyfos G, Stefanidis I, Stamatatos I, Kerasidis S, Giannakakis S, Kastrisios G, Papacharalampous G, Maltezos C. Acute type B aortic dissection: update on proper management. JOURNAL OF ACUTE DISEASE 2014. [DOI: 10.1016/s2221-6189(14)60058-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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CT Dynamics: The Shift from Morphology to Function. CURRENT RADIOLOGY REPORTS 2013. [DOI: 10.1007/s40134-012-0004-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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14
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CT Angiography of the Aorta and Aortic Diseases. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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