The complementary role of magnetic resonance imaging, doppler echocardiography, and computed tomography in the diagnosis of dissecting thoracic aneurysms

Goldman, Anthony P.; Kotler, Morris N.; Scanlon, Mary; Ostrum, Bernard J.; Parameswaran, R.; Parry, Wayne R.

doi:10.1016/0002-8703(86)90648-4

Cited by 68 publications

(6 citation statements)

References 30 publications

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“…19 21 Both modalities represent recent advances in clinical imaging technology and have been declared useful and reliable for the assessment of thoracic aortic disease22 25; further technical refinement such as multiplanar TEE has just become available. However, a randomized controlled validation study comparing monoplanar TEE and MRI to an independent morphological reference is not yet available.…”

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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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confidence: 99%

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

et al. 1992

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“…Occasionally the initial presentation may be haemoptysis due to rupture of the dissection into the pulmonary artery, 17 or through the wall of the oesophagus 18 . Heart block has been reported due to propagation of haematoma into the interatrial septum 19 …”

Section: Clinical Presentationmentioning

confidence: 99%

Aortic Dissection

Ponraj

Pepper

1992

Int J Clinical Practice

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SUMMARYAortic dissection, once thought to be rare, is the most common catastrophe of the aorta, being twice as common as ruptured abdominal aortic aneurysm.1 In one Inner London borough, aortic dissection accounted for 4.2% of sudden deaths in men over a three‐year period.2 Early diagnosis and prompt treatment are crucial to achieving a successful outcome, because the events that influence survival occur early in the course of the disease.Surgical repair of aortic dissection is an uncommon operation in the United Kingdom. The Cardiac Surgical Register for 1988 (the most recent year available for analysis) reveals that 208 operations were performed to replace the ascending aorta, 12 operations to replace the aortic arch and 15 operations on the descending aorta during that year.

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“…Wahl zur postoperativen Darstellung war [23], haben sich in jiingerer Zeit Alternativen in Form der Computertomographie mit und ohne Kontrastmittelgabe [6,14,18,19], der digitalen Subtraktionsangiographie [16] oder auch der Echokardiographie [15,26] konventionell transthorakal oder j/ingst transoesophageal empfohlen. Wahl zur postoperativen Darstellung war [23], haben sich in jiingerer Zeit Alternativen in Form der Computertomographie mit und ohne Kontrastmittelgabe [6,14,18,19], der digitalen Subtraktionsangiographie [16] oder auch der Echokardiographie [15,26] konventionell transthorakal oder j/ingst transoesophageal empfohlen.…”

Section: Postoperative Control and Follow-up Of Thoracic Aortic Diseaunclassified

Postoperative Erfolgs- und Verlaufskontrollen thorakaler Aortenerkrankungen mittels Kernspintomographie

Ennker

Schubert

Schneider

et al. 1989

Langenbecks Arch Chiv

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Operations of the thoracic aorta for aneurysms, dissections, or congenital malformations may lead to early or late complications. Therefore, postoperative control for documentation of the surgical results, for exclusion of early changes and for comparison with later controls is mandatory. To demonstrate that magnetic resonance imaging (MRI), which we already had used with good results for preoperative studies is also able to detect postoperative abnormalities, we examined 30 patients with thoracic aortic disease (20 male, 10 female, mean age 53 +/- 13.7 years) with this diagnostic tool. There were 19 arteriosclerotic aneurysms, 10 dissections, and one aortic tumor. With MRI it was possible in all patients to visualize the results of the surgical treatment postoperatively. Early postoperative complications could be excluded, or demonstrated in one case of a retrograde aortic dissection or a hematopericardium. These pathological findings could also be shown by arterial digital subtraction angiography or echocardiography. Using MRI for follow-up of aortic dissections, the development of an aneurysm of the aortic root in a Marfan-patient could be detected. In all these patients, it was possible to differentiate true and false lumen and to detect the origin of major side branches. The diagnostic advantages of MRI, which we compared with other imaging methods, as echocardiography, computed tomography or angiography are that postoperative complications of thoracic aortic aneurysm surgery can be reliably detected and visualized in 3 different planes. Non-invasiveness, the omission of ionizing radiation and no risk of contrast media application underline that magnetical resonance imaging is an ideal method for follow-up after operation of the thoracic aorta.

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The complementary role of magnetic resonance imaging, doppler echocardiography, and computed tomography in the diagnosis of dissecting thoracic aneurysms

Cited by 68 publications

References 30 publications

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

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

Aortic Dissection

Postoperative Erfolgs- und Verlaufskontrollen thorakaler Aortenerkrankungen mittels Kernspintomographie

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