Aortic dissection: sensitivity and specificity of MR imaging.

Kersting-Sommerhoff, B; Higgins, C B; White, Richard D.; Sommerhoff, Christian P.; Lipton, Martin J.

doi:10.1148/radiology.166.3.3340758

Cited by 118 publications

(18 citation statements)

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“…18 Recently, MRI has emerged as a promising diagnostic technique with potential for detailed anatomic mapping of the aorta. 24 To assess the diagnostic reliability of monoplanar TEE and MRI in suspected thoracic aortic dissection, the comparison was designed in a prospective fashion. Each patient was subjected to both imaging modalities in random order upon arrival; the results of both MRI and TEE were compared within individuals and validated against the independent morphological reference of contrast angiography and/or visual inspection at surgery or necropsy.…”

Section: Methodsmentioning

confidence: 99%

Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

et al. 1992

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BACKGROUND Aortic dissection requires prompt and reliable diagnosis to reduce the high mortality. The purpose of this study was to assess the reliability of both ECG-triggered magnetic resonance imaging (MRI) and transesophageal two-dimensional echocardiography combined with color-coded Doppler flow imaging (TEE) for the diagnosis of thoracic aortic dissection and associated epiphenomena. METHODS AND RESULTS Fifty-three consecutive patients with clinically suspected aortic dissection were subjected to a dual noninvasive imaging protocol in random order; imaging results were compared and validated against the independent morphological "gold standard" of intraoperative findings (n = 27), necropsy (n = 7), and/or contrast angiography (n = 53). No serious side effects were encountered with either imaging method. In contrast to a precursory screening transthoracic echogram, the sensitivities of both MRI and TEE were 100% for detecting a dissection of the thoracic aorta irrespective of its location. The specificity of TEE, however, was lower than the specificity of MRI for a dissection (TEE, 68.2% versus MRI, 100%; p less than 0.005), which resulted mainly from false-positive TEE findings confined to the ascending segment of the aorta (TEE, 78.8% versus MRI, 100%; p less than 0.01). In addition, MRI proved to be more sensitive than TEE in detecting the formation of thrombus in the false lumen of both the aortic arch (p less than 0.01) and the descending segment of the aorta (p less than 0.05). There were no discrepancies between the two imaging techniques in detecting the site of entry to a dissection, aortic regurgitation, or pericardial effusion. CONCLUSIONS Both MRI and TEE are atraumatic, safe, and highly sensitive methods to identify and classify acute and subacute dissections of the entire thoracic aorta. TEE, however, is associated with lower specificity for lesions in the ascending aorta. These results may still favor TEE as a semi-invasive diagnostic procedure after a precursory screening transthoracic echogram in suspected aortic dissection, but they establish MRI as an excellent method to avoid false-positive findings. Anatomic mapping by MRI may emerge as the most comprehensive approach and morphological standard to guide surgical interventions.

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Section: Methodsmentioning

confidence: 99%

Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

et al. 1992

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“…Of note, MRI is an observerdependant technology with reported sensitivities ranging from 52% to 100% depending on the experience of the radiologist. 21,27 A recent systematic review compared the diagnostic accuracy of TEE, CT scanning and MRI. The authors concluded that these studies are equally reliable for diagnosing or ruling out thoracic aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

The utility of multiple imaging modalities to diagnose acute aortic dissection

Hurley

Ducharme

2008

CJEM

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A 21-year-old man with Marfan syndrome and known aortic root aneurysm presented to our emergency department with symptoms suggestive of acute aortic dissection. The patient was hemodynamically stable and bilateral upper extremity blood pressures were similar. There was no mediastinal widening on portable chest radiograph. Both contrast CT and retrograde angiography of the aorta failed to identify dissection. Subsequent transesophageal echocardiography demonstrated a Stanford classification type A dissection. This case demonstrates the utility of multiple imaging modalities for identifying aortic dissection in high-risk patients. RÉSUMÉUn jeune homme de 21 ans atteint du syndrome de Marfan avec présence connue d'un anévrisme de la racine aortique s'est présenté à l'urgence avec des symptômes évoquant une dissection aiguë de l'aorte. Le patient était stable sur le plan hémodynamique et les pressions artérielles bilatérales des membres supérieurs étaient similaires. Les résultats de la radiographie pulmonaire réalisée sur un appareil portatif n'indiquaient pas d'élargissement du médiastin. Ni la tomodensitométrie avec agent de contraste ni l'angiographie rétrograde de l'aorte n'ont permis de déceler la dissection. Une échocardiographie transoesophagienne subséquente a montré qu'il s'agissait d'une dissection de type A selon la classification de Stanford. Ce cas met en évidence l'utilité d'avoir recours à de multiples techniques d'imagerie médicale pour établir un diagnostic de dissection aortique chez les patients à haut risque.

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“…This technique was not available to us at the time our patient was admitted. MRI is also a valuable diagnostic method [10]. Because of the nature of the examination and its long acquisition time, MRI is limited to patients who are hemodynamically stable.…”

Section: Discussionmentioning

confidence: 99%

Dissecting Aortic Aneurysm – Failure of Standard Noninvasive and Invasive Diagnostic Techniques

Barasch¹,

Vered²,

Shotan³

et al. 1991

Cardiology

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The diagnosis of cardiac tamponade due to dissection of an ascending aortic aneurysm in a middle-aged woman was not confirmed by the usual noninvasive and invasive procedures. The decision for surgery was based on clinical grounds only, resulting in an unnecessary delay of surgical intervention. Although some of the current noninvasive techniques seem to be most useful in the investigation of these patients, the clinical findings remain the cornerstone of a correct diagnosis.

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Aortic dissection: sensitivity and specificity of MR imaging.

Cited by 118 publications

References 0 publications

Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

The utility of multiple imaging modalities to diagnose acute aortic dissection

Dissecting Aortic Aneurysm – Failure of Standard Noninvasive and Invasive Diagnostic Techniques

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Aortic dissection: sensitivity and specificity of MR imaging.

Cited by 118 publications

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Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

Diagnosis of thoracic aortic dissection. Magnetic resonance imaging versus transesophageal echocardiography.

The utility of multiple imaging modalities to diagnose acute aortic dissection

Dissecting Aortic Aneurysm &ndash; Failure of Standard Noninvasive and Invasive Diagnostic Techniques

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Dissecting Aortic Aneurysm – Failure of Standard Noninvasive and Invasive Diagnostic Techniques