Computed tomography of aortic dissection.

Lardé, D; Belloir, C; Vasile, N; Frija, J.; Ferrane, J

doi:10.1148/radiology.136.1.7384489

Cited by 60 publications

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“…[10][11][12][13][14][15][16][17][18][19][20] Echocardiography is the method of choice for diagnosis of aortic dissection because it is less invasive and less expensive than other methods. Transthoracic echocardiography is less reliable in patients with obesity, pulmonary emphysema, or thorax deformation.…”

mentioning

confidence: 99%

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

et al. 1989

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Follow-up of 18 patients with aortic dissection (five with type I, one with type II, 11 with type III dissection according to DeBakey) by transesophageal, two-dimensional and color-coded Doppler echocardiography showed a persistence of the false lumen in five of seven patients (71%) after surgery and in nine of 11 patients (82%) after medical therapy. In two patients treated with surgery, the dissected part of the aorta had been resected, whereas in two patients treated medically, a progressive and complete obliteration of the false lumen was observed. In the false lumen, thrombus formation was absent in four, localized in four, and progressive in six patients. Flow within the false lumen could be registered in 14 patients, and two distinct flow patterns were differentiated (laminar biphasic flow or slowly circulating flow). Persisting intimal tears were visualized by two-dimensional echocardiography in four patients, whereas colorcoded Doppler showed an additional one to three intimal tears in the descending aorta in 10 patients. Flow across these intimal tears was biphasic in 75% of patients; that is, systolic flow was directed from the true to the false lumen with diastolic flow reversal. Unidirectional flow was detected in 25% of the communications, directed in 20%o from the true to the false lumen, serving as an entry only and in one (5%) as reentry only. Additional information concerning complications like extension of the dissection (one of 18 patients), localized dilatation of the aorta (two of 18 patients), mediastinal hematoma (one of 18 patients), or aortic regurgitation (three of 18 patients) were detected by this method. Concerning the morphologic findings and the detection of flow characteristics, the transesophageal approach was superior to conventional echocardiography especially in the descending thoracic aorta. Thus, transesophageal twodimensional and color-coded Doppler echocardiography seems to be an ideal method not only for the easy detection of aortic dissection but also for follow-up. (Circulation 1989;80:24-33 Transesophageal echocardiography overcomes these methodologic limitations and is of great diagnostic value because of high-quality cross-sectional images of the ascending and descending thoracic aorta even in patients in shock or on mechanical ventilation.23-30 Surgery without further diagnostic investigation has been performed successfully in emergency cases.30 In combination with color-coded Doppler flow imaging, which superimposes flow information

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confidence: 99%

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

et al. 1989

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“…Until recently, angiography has been regarded as the definitive investigation for aortic dissection; however, this involves arterial puncture and catheterization of an acutely ill patient and an intimal flap can escape detection at aortography if not projected tangentially (Godwin & Korobkin, 1983). A number of reports suggest that computed tomography is at least as accurate and in some cases superior to aortography in the detection of intimal flaps (Godwin_& Korobkin, 1983) and should be considered the investigation of choice in aortic dissection (Larde et al, 1980). It is relatively non-invasive and because of its cross-sectional format, projection is not a problem.…”

Section: Discussionmentioning

confidence: 99%

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Nicholson¹,

Hayward²

1988

The British Journal of Radiology

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A 65-year-old man with a past history of hypertension was admitted after collapsing in the street. He complained of chest pain and dizziness following brief loss of consciousness. Two years previously he had suffered a right-sided cerebrovascular accident but had made a good recovery. Examination was normal apart from a systolic blood pressure of 80 mmHg which responded to one unit of plasma expander. Routine biochemical investigations and an electrocardiogram were normal. The initial antero-posterior and lateral chest radiographs are shown in Fig 1. A differential diagnosis of myocardial infarction or pulmonary embolism was made. During the night his condition deteriorated and he complained of further chest pain. A second electrocardiogram was normal and a repeat supine chest radiograph is shown in Fig. 2.What significant abnormalities are present on the chest radiographs, what is the likely diagnosis and how would you proceed? Figure 1. (a) Antero-posterior and (b) lateral chest radiographs taken on admission. Figure 2. Supine chest radiograph taken 12 h after admission.

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“…Despite being widely used to diagnose ascending aortic dissection [ 4 , 5 , 6 , 7 , 8 , 9 ], CTA may provide false-positive results, as factors such as streak artifacts, pericardial recesses, the left brachiocephalic vein, thickened pleura, and, most importantly, motion artifacts from the pulsating aorta may simulate an intimal flap or false channel [ 10 , 11 ]. Electrocardiographic (ECG) gating/triggering eliminates cardiac pulsation motion artifacts, thus improving the diagnosis of an acute aortic dissection, enabling clinicians to precisely localize and characterize the site of the primary intimal tear, with important clinical implications [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Comparing the Diagnostic Performance of ECG Gated versus Non-Gated CT Angiography in Ascending Aortic Dissection: A GRRAS Study

et al. 2022

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Rationale and Objective: Thoracic CT angiography (CTA) for ascending aortic dissection, a life-threatening emergency, is performed routinely without Electrocardiographic (ECG) gating, therefore allowing the apparition of a pulsation artefact. We aimed to evaluate and compare the diagnostic performance, the inter and intra-reporter agreement of ECG gated CTA and non-ECG gated CTA for detecting ascending aortic dissection, considering their training level. Our hypothesis is that ECG gated CTA has superior diagnostic accuracy for ascending aortic dissection compared to non-gated CTA. Materials and Methods: We collected data using 24 questions survey using clinically validated CT examinations. Sixty-six respondents (medical students, radiology residents, and consultants) blinded to the actual diagnosis independently evaluated the images pertaining to the presence of ascending aortic dissection. The reference standard was represented by clinical and imaging diagnosis. Inter-rater and inter-group concordance was evaluated; the agreement with reference tests was calculated and assessed as a function of reporters’ training level. Results: Reporters’ ascending aortic dissection assessment showed a better correlation with the reference standard in the ECG gated CTA. The inter-rater correlation was higher in the ECG gated CTA compared to non-ECG gated CTA. Observers’ confidence for diagnosing ascending aortic dissection was higher in the ECG gated CTA. Statistically significant differences (p < 0.05) were found between different training levels when assessing non-ECG gated examinations. Conclusions: ECG gated CTA shows a higher diagnostic performance for ascending aortic dissection than non-ECG gated CTA, regardless of the reporters’ training level.

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Computed tomography of aortic dissection.

Cited by 60 publications

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Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

Ambulatory follow-up of aortic dissection by transesophageal two-dimensional and color-coded Doppler echocardiography.

Cause for collapse

Comparing the Diagnostic Performance of ECG Gated versus Non-Gated CT Angiography in Ascending Aortic Dissection: A GRRAS Study

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