Multimodality Imaging of Aortic Dimensions: Comparison of Transthoracic Echocardiography with Multidetector Row Computed Tomography

Tsang, James F.; Lytwyn, Matthew; Farag, Ashraf; Zeglinski, Matthew R.; Wallace, Kerrett; daSilva, Megan; Bohonis, Sheena; Walker, Jonathan R.; Tam, James W.; Strzelczyk, Jacek; Jassal, Davinder S.

doi:10.1111/j.1540-8175.2012.01666.x

Cited by 22 publications

(15 citation statements)

References 21 publications

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“…Although the specificity of TTE for detecting aortic dilation was good, the sensitivity was only 55%‐60%, which implies that by imaging the ascending aorta in one plane only on 2DTTE, the true maximal diameter may easily be missed. This is in agreement with previous literature . One previous study looked at the ability of TTE to identify an aneurysm of the aortic root or ascending aorta in patients with a bicuspid aortic valve .…”

Section: Discussionsupporting

confidence: 92%

Screening for thoracic aortic pathology: Clinical practice in a single tertiary center

Bons

Assis

Dekker

et al. 2018

Congenital Heart Disease

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Objective The aim is to present current clinical practice of thoracic aorta screening in a tertiary referral center. We identified how often imaging techniques were used for screening and established the value of transthoracic echocardiography (TTE) in comparison with computed tomography (CT) to detect aortic dilation. We also investigated which additional abnormalities of the heart, aorta or smaller arteries were discovered. Design All patients ≥15 years who visited our tertiary center in 2012‐2016 for first thoracic aortic screening were retrospectively included. Diameters of the sinus of Valsalva (SoV) and maximum ascending aorta (AA) were compared between TTE and CT. The sensitivity and specificity of TTE to detect aortic dilation (≥40 mm) was assessed with CT as reference standard. Intracardiac abnormalities found with TTE and arterial abnormalities found with CT were identified. Results In total 349 patients (155 men, age 41 ± 15 years, 10% genetic mutation) were included. Screening was performed with TTE only in 35% and with TTE and CT in 65%. Patients who underwent TTE only were younger, had less often hypertension and less often a family history of aortic pathology. Although there was a good correlation between TTE and CT, the diameters measured with TTE were typically lower (SoV −1.0, 95%CI −6.6 to 4.7 and AA −0.4, 95%CI −6.5 to 5.8). Sensitivity of TTE for detecting aortic dilation was 61% (SoV) and 57% (AA) and specificity was 96% (SoV) and 100% (AA). Valve abnormalities, ventricular dilation or reduced ventricular function was found with TTE in 26 patients (7%). In 47 patients (13%) ascending aortic dilation was diagnosed and in 10 patients (4%) relevant peripheral arterial abnormalities were identified using CT. Conclusions Most often patients received both TTE and CT (65%). Since TTE showed a low sensitivity to detect aortic dilation, CT imaging is advised at least once in patients referred for thoracic aortic screening.

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Section: Discussionsupporting

confidence: 92%

Screening for thoracic aortic pathology: Clinical practice in a single tertiary center

Bons

Assis

Dekker

et al. 2018

Congenital Heart Disease

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“…4 The establishment of normative values and reference ranges, taking into account aging and gender, is of great importance for diagnosis, prognosis, serial monitoring, and determining the optimal timing for surgical intervention. Normal values and proximal aortic diameters have been reported using different imaging techniques, from the pioneer studies based on M-mode and 2D echocardiography 9,10 to more recent studies obtained using CT 7,8,20,[23][24][25] and MRI. 5,26 Despite differences in image acquisition methods, temporal and spatial resolution, and signal-to-noise ratios, CT, MRI, TTE, and transesophageal echocardiography (TEE) have evolved as near equal standards for assessing aortic root size.…”

Section: Normal Aortic Dimensionsmentioning

confidence: 97%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

543

434

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“…Nevertheless, other authors reported that, despite good correlation, the leading-to-leading method by TTE underestimates CT diameters by 3–4 mm 16. A possible explanation for this underestimation is that the long-axis view by TTE usually cuts the minor axis of the aortic root and cannot guarantee crossing its centre, resulting in underestimation of the true aortic dimensions.…”

Section: Aortic Sizementioning

confidence: 99%

Imaging aortic aneurysmal disease

Evangelista

2014

Heart

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Imaging techniques play a crucial role in the diagnosis, follow-up and management of aortic aneurysms. Ultrasound, CT and MRI have strengths and limitations in the assessment of this disease depending on the aorta segment involved, reason for the study (screening, follow-up or surgical indication) and patient characteristics. Ultrasound, transthoracic or abdominal, is highly useful in the diagnosis and follow-up of proximal ascending aorta and abdominal aorta aneurysms, respectively. However, other imaging modalities may be required to confirm measurements and add information on adjacent structures or the involvement of aortic branches. Transoesophageal echocardiography is frequently limited to perioperative indications. CT plays a central role in the diagnosis, risk stratification and management of most aneurysms, particularly those located distal to the proximal ascending aorta. Advantages of CT over other imaging modalities include rapid image acquisition, its multiplanar capacity with submillimetric spatial resolution and wide availability. The main limitations of CT are the radiation exposure and need for nephotoxic contrast administration. MRI is less readily available but overcomes these limitations and adds functional and biomechanical information, and is mainly indicated in young individuals who require repetitive studies and long-term follow-up. Aortic diameters are the cornerstone of current clinical practice in aortic aneurysms, and some limitations in accuracy and reproducibility measurements may generate errors in clinical decision making. Better understanding of imaging modalities, beyond the simple clinical application of diameters, may improve the management of this disease. In addition, new biomechanical and metabolic information could potentially provide a more reliable prediction of the risk of aneurysm rupture.

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Multimodality Imaging of Aortic Dimensions: Comparison of Transthoracic Echocardiography with Multidetector Row Computed Tomography

Abstract: 2DTTE is a feasible, accurate, and reproducible method for the noninvasive assessment of thoracic aortic diameters as compared to MDCT.

Cited by 22 publications

References 21 publications

Screening for thoracic aortic pathology: Clinical practice in a single tertiary center

Screening for thoracic aortic pathology: Clinical practice in a single tertiary center

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Imaging aortic aneurysmal disease

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