Three-Dimensional Visualization and Imaging of the Entry Tear and Intimal Flap of Aortic Dissection Using CT Virtual Intravascular Endoscopy

Qi, Yafei; Ma, Xiaoyuan; Li, Gang; Ma, Xiang; Wang, Qing; Yu, Dexin

doi:10.1371/journal.pone.0164750

Cited by 10 publications

(6 citation statements)

References 22 publications

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“…There is limited research exploring the relationship between the number of tears and in-hospital mortality in patients with aortic dissection [16][17][18]. Our study indicates that having two or more tears is a protective factor for postoperative mortality in aortic dissection patients (OR = 0.094, 95% CI: 0.012-0.717, P = 0.022).…”

Section: Discussionmentioning

confidence: 60%

CTA Imaging Features and Prognosis in Emergency Type A Aortic Dissection Admissions

Matniyaz,

Wang,

Zhang

et al. 2023

Preprint

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Background Acute Type A aortic dissection (ATAAD) is a life-threatening condition requiring prompt surgical intervention. This retrospective study aimed to identify preoperative computed tomography angiography (CTA) features associated with in-hospital mortality in ATAAD patients. We examined specific CTA characteristics and their implications for patient outcomes. Methods We conducted a retrospective analysis of 384 patients diagnosed with ATAAD who underwent emergency surgery at Nanjing Drum Tower Hospital between March 2019 and March 2022. Their pre-admission CTA images were interpreted by experienced radiologists. The patients were divided into two groups: the survival group and the mortality group. We used logistic regression to assess the impact of various CTA features finding on in-hospital mortality rates between these two groups. Results Our study revealed significant associations between specific CTA findings and in-hospital mortality in ATAAD patients. Notably, the absence of visible fenestration (OR = 2.296, 95% CI: 1.005–5.245, P = 0.049), involvement of the superior mesenteric artery (OR = 4.805, 95% CI: 1.977–11.677, P < 0.001), a total ascending aortic diameter ≥ 4.7 cm (OR = 3.040, 95% CI: 1.326–6.970, P = 0.009), and the presence of multiple tears (OR = 0.094, 95% CI: 0.012–0.717, P = 0.022) were linked to mortality risk. These associations held true even after adjusting for potential confounders in multivariable analyses. The logistic regression model demonstrated good discriminative ability with an area under the ROC curve of 0.726. Conclusion In conclusion, this study identified preoperative CTA features that can help predict in-hospital mortality in ATAAD patients. The absence of visible fenestration and involvement of the superior mesenteric artery, a total ascending aortic diameter ≥ 4.7 cm, the presence of multiple tears were significant risk factors. These findings emphasize the importance of careful assessment and consideration of these CTA characteristics when managing ATAAD patients. Future research should explore additional factors and consider multicenter, prospective studies for a more comprehensive understanding of ATAAD prognosis and treatment strategies. Trial registration The study received approval from the ethical committees of Nanjing Drum Tower Hospital (No.2022-157-01) and individual consent for this retrospective analysis was waived.

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Section: Discussionmentioning

confidence: 60%

CTA Imaging Features and Prognosis in Emergency Type A Aortic Dissection Admissions

Matniyaz,

Wang,

Zhang

et al. 2023

Preprint

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“…VIE generated from CCTA data provides unique intraluminal views that allow qualitative assessment of the arterial lumen. Several other studies have used VIE to evaluate the aorta [ 19 , 20 , 21 , 22 , 23 , 24 ], but only three studies have used VIE to assess coronary arteries [ 25 , 26 , 27 ]. Only one study has evaluated the diagnostic value of VIE in assessing coronary stenosis, via an investigation of 61 patients with calcified coronary plaques, and showed a significant improvement in specificity and positive predictive value when compared with CCTA [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…Post-processing of CT data was performed with a CT number thresholding technique [ 27 , 28 ]. Generation of VIE images of coronary plaques and coronary lumen depends on the selection of an appropriate CT threshold, which was determined by measuring the CT attenuation in the ascending aorta according to previous reports [ 23 , 24 , 25 ], as illustrated in Figure 1 . An upper CT threshold of 150 to 200 HU was applied to remove the contrast-enhanced blood from the coronary artery for optimal demonstration of intraluminal views of coronary walls.…”

Section: Methodsmentioning

confidence: 99%

“…Virtual intravascular endoscopy (VIE), a CCTA-generated 3D visualization tool, is another approach that provides unique intraluminal views of the blood vessels, including endovascular stents or stent grafts [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], thus having potential to overcome the limitations of CCTA. To our knowledge, there are very few reports investigating the application of virtual intravascular endoscopy (VIE) in assessing coronary arteries [ 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

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Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques

Tsay

Sun

et al. 2022

Diagnostics

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Coronary computed tomography angiography (CCTA) is a widely used imaging modality for diagnosing coronary artery disease (CAD) but is limited by a high false positive rate when evaluating coronary arteries with stents and heavy calcifications. Virtual intravascular endoscopy (VIE) images generated from CCTA can be used to qualitatively assess the vascular lumen and might be helpful for overcoming this challenge. In this study, one hundred subjects with coronary stents underwent both CCTA and invasive coronary angiography (ICA). A total of 902 vessel segments were analyzed using CCTA and VIE. The vessel segments were first analyzed on CCTA alone. Then, using VIE, the segments were classified qualitatively as either negative or positive for in-stent restenosis (ISR) or CAD. These results were compared, using ICA as the reference, to determine the added diagnostic value of VIE. Of the 902 analyzed vessel segments, CCTA/VIE had sensitivity, specificity, accuracy, positive predictive value, and negative predictive value (shown in %) of 93.9/90.2, 96.2/98.2, 96.0/97.7, 70.0/83.1, and 99.4/99.0, respectively, in diagnosing ISR or CAD, with significantly improved specificity (p = 0.025), accuracy (p = 0.046), and positive predictive value (p = 0.047). VIE can be a helpful addition to CCTA when evaluating coronary arteries.

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“…Other disadvantages of CT are that the obtained images are static and tissue characterization is only based on CT values, while the intimal surface of the aorta cannot be visualized. A recent reported noted that virtual intravascular endoscopy is useful to reveal the entry shape and spatial relationship of the flaps [14]. However, with virtual intravascular endoscopy, axial images with a section thickness of 1 mm obtained during an optimal cardiac phase are transferred to the workstation for post-processing.…”

Section: Discussionmentioning

confidence: 99%

Aortic angioscopy assisted thoracic endovascular repair for chronic type B aortic dissection

Nishi

Higuchi

Takahashi

et al. 2020

Journal of Cardiology

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Recent advances in imaging modalities have led to their greater availability and increased use, particularly computed tomography (CT), while improvements in surgical and anesthetic techniques have resulted in better survival for patients with type A acute aortic dissection [1]. Furthermore, expanded use of endovascular intervention techniques is having a positive effect on management of type B dissection cases [2]. Surgical treatment is usually indicated for a type A acute aortic dissection and medical management is also used for uncomplicated type B cases [3], although long-term outcome results indicate a significant rate of late mortality from late complications in both groups [3,4]. Such complications, especially those involving the descending thoracic aorta in type B aortic dissection cases or type A cases with a persistent false lumen that undergo surgery, are increasingly being managed by endovascular techniques [1,2,4].Although conventional imaging modalities, such as CT, magnetic resonance imaging (MRI), and transesophageal echocardiography (TEE), have been used to diagnose aortic diseases, the ability

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Three-Dimensional Visualization and Imaging of the Entry Tear and Intimal Flap of Aortic Dissection Using CT Virtual Intravascular Endoscopy

Cited by 10 publications

References 22 publications

CTA Imaging Features and Prognosis in Emergency Type A Aortic Dissection Admissions

CTA Imaging Features and Prognosis in Emergency Type A Aortic Dissection Admissions

Added Value of Computed Tomography Virtual Intravascular Endoscopy in the Evaluation of Coronary Arteries with Stents or Plaques

Aortic angioscopy assisted thoracic endovascular repair for chronic type B aortic dissection

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