Role of Computed Tomography in Assessment of the Thoracic Aorta

Abstract

Thoracic aortic disease is increasing in prevalence and can result in serious morbidity and mortality. Computed tomography (CT) angiography is an important imaging modality for assessment of thoracic aortic pathology due to wide availability, rapid acquisition, reproducibility, superior spatial and temporal resolution, and capability for 3D image post-processing. CT is the preferred imaging modality in the acute setting to rapidly identify patients with acute aortic syndromes including dissection, intramural hematoma, and penetrating aortic ulcer. CT also plays an important role in post-procedural surveillance of the thoracic aorta for early and late complications from open or endovascular repair. Incidentally detected thoracic aortic aneurysms and congenital aortic anomalies such as coarctation can be thoroughly characterized and followed over time for potential elective intervention. Drawbacks of CT include exposure to radiation and iodinated contrast media; however, recent strategies for dose reduction and contrast optimization have significantly decreased these risks. Electrocardiogram (ECG)-gated CT angiography provides additional information about the aortic root, coronary arteries, and other cardiac structures without motion artifacts.

Conservatively treated coronary malperfusion associated with acute type A dissection before aortic root replacement

“…When an ischemic change is suspected to be related to aortic dissection, ECG-gated cardiac MDCT should be performed before catheterization, because it is a non-invasive method for assessing the coronary arteries and can be performed quickly. ECG-gated cardiac MDCT reduces the severity of motion artifacts and makes it easier for the physician to assess the presence of an intimal tear in the aortic root and dissection extension into the coronary arteries [7][8][9][10]. When planning the surgical approach, it is important to assess the presence of aortic regurgitation, pericardial effusion, the extension of the dissection into major aortic branches, the location of entry and reentry sites, and the presence of thrombosis in the false lumen.…”

Initial experience with cinematic rendering for chest cardiovascular imaging

“…Multidetector CT is the imaging modality of choice to evaluate acute and chronic conditions of the aorta. 8 Additionally, 3D post-processing techniques have long been known to provide important information regarding the aorta. 9 Although studies evaluating the advantages and disadvantages of CR relative to VR have yet to be carried out, initial clinical experience highlights the potential of CR to provide valuable information in this context.…”

Advances in the diagnosis of acute aortic syndromes: Role of imaging techniques

“…Digital subtraction angiography may be used for congenital aortic disease. 29,30 The most widely used technique is the MD-CT (multi-detector computed tomography) because it reduces image acquisition time with better spatial and temporal resolution compared to single-detector CT. Image acquisition generally follows this order: first, sequences without contrast, an arterial phase following contrast infusion, and, in some cases, delayed sequence images.…”