Multidetector CT of Aortic Dissection: A Pictorial Review

Abstract

Aortic dissection is the most common acute emergency condition of the aorta and often has a fatal outcome. Outcome is determined by the type and extent of dissection and the presence of associated complications (eg, cerebral sequelae, aortic branch involvement, pericardial involvement, and visceral involvement), with early diagnosis and treatment being essential for improved prognosis. Aortic dissections are classified on the basis of the site of the intimal tear according to the Stanford classification system. Type A aortic dissection involves the ascending thoracic aorta and may extend into the descending aorta, whereas in a type B dissection the intimal tear is located distal to the left subclavian artery. Type A dissection typically requires urgent surgical intervention, whereas type B dissection can often be treated medically. Modern multidetector computed tomography (CT) is a fast, widely available imaging modality with high sensitivity and specificity. Multidetector CT allows the early recognition and characterization of aortic dissection as well as determination of the presence of any associated complications, findings that are essential for optimizing treatment and improving clinical outcomes.

Imaging the posterior mediastinum: a multimodality approach

“…Aortic dissection Dissection is the most common aortic emergency and has a poor prognosis (29,34). It results from a tear in the intimal layer of aortic wall, allowing inflow of blood through the medial layer.…”

“…According to the Stanford classification, dissections of the ascending aorta are categorized as type A and account for 62% of cases, whereas dissections of the descending aorta are categorized as type B and account for 38% of cases (32,35). Type A dissections require urgent surgical repair, as they have a mortality rate over 50% within 48 hours if untreated (32,34). Conversely, type B dissections are generally managed conservatively, with follow-up examinations every three to six months (35).…”

“…In 90% of cases, CXR shows such nonspecific abnormalities as abnormal cardiac contour, widening of the mediastinum, and displacement of aortic wall calcifications (34). Therefore, cross-sectional imaging plays a key role in the diagnosis of aortic dissection, which is essential for prompt and appropriate treatment (36).…”

Time-resolved Three-dimensional Magnetic Resonance Velocity Mapping of Chronic Thoracic Aortic Dissection: A Preliminary Investigation

“…[1][2][3] Contrast-enhanced computed tomography (CT) or 3-dimensional (3D) magnetic resonance (MR) angiography is the standard technique for diagnosing and classifying thoracic aortic dissection, visualizing mural thrombus, intramural hematoma, and ulcer-like projection (ULP), and following up patients with this disease. [3][4][5][6][7][8][9] However, the frequent involvement of renal arteries in aortic dissection 1,7 precludes the use of contrast agents in some patients with renal insu‹ciency and risk for contrast-induced nephropathy and nephrogenic systemicˆbrosis.…”

Difficulties in Diagnosis and Ways to Optimize Computed Tomography in Acute Aortic Lesions

“…В то же время сохраняется риск диагно-стических ошибок, которые довольно скудно описаны в литературе [5,[12][13][14][15][16][17][18][19]. Опасными яв-ляются ошибки любого характера: ложнополо-жительные результаты могут приводить к не-обоснованной операции, в т.ч.…”