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      CT and MR imaging of the thoracic aorta

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          Abstract

          At present time, both CT and MRI are valuable techniques in the study of the thoracic aorta. Nowadays, CT represents the most widely employed technique for the study of the thoracic aorta. The new generation CTs show sensitivities up to 100% and specificities of 98-99%. Sixteen and wider row detectors provide isotropic pixels, mandatory for the ineludible longitudinal reconstruction. The main limits are related to the X-ray dose expoure and the use of iodinated contrast media. MRI has great potential in the study of the thoracic aorta. Nevertheless, if compared to CT, acquisition times remain longer and movement artifact susceptibility higher. The main MRI disadvantages are claustrophobia, presence of ferromagnetic implants, pacemakers, longer acquisition times with respect to CT, inability to use contrast media in cases of renal insufficiency, lower spatial resolution and less availability than CT. CT is preferred in the acute aortic disease. Nevertheless, since it requires iodinated contrast media and X-ray exposure, it may be adequately replaced by MRI in the follow up of aortic diseases. The main limitation of MRI, however, is related to the scarce visibility of stents and calcifications.

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          The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease.

          P. Hagan, C. A. Nienaber, E. Isselbacher … (2000)
          Acute aortic dissection is a life-threatening medical emergency associated with high rates of morbidity and mortality. Data are limited regarding the effect of recent imaging and therapeutic advances on patient care and outcomes in this setting. To assess the presentation, management, and outcomes of acute aortic dissection. Case series with patients enrolled between January 1996 and December 1998. Data were collected at presentation and by physician review of hospital records. The International Registry of Acute Aortic Dissection, consisting of 12 international referral centers. A total of 464 patients (mean age, 63 years; 65.3% male), 62.3% of whom had type A dissection. Presenting history, physical findings, management, and mortality, as assessed by history and physician review of hospital records. While sudden onset of severe sharp pain was the single most common presenting complaint, the clinical presentation was diverse. Classic physical findings such as aortic regurgitation and pulse deficit were noted in only 31.6% and 15.1% of patients, respectively, and initial chest radiograph and electrocardiogram were frequently not helpful (no abnormalities were noted in 12.4% and 31.3% of patients, respectively). Computed tomography was the initial imaging modality used in 61.1%. Overall in-hospital mortality was 27.4%. Mortality of patients with type A dissection managed surgically was 26%; among those not receiving surgery (typically because of advanced age and comorbidity), mortality was 58%. Mortality of patients with type B dissection treated medically was 10.7%. Surgery was performed in 20% of patients with type B dissection; mortality in this group was 31.4%. Acute aortic dissection presents with a wide range of manifestations, and classic findings are often absent. A high clinical index of suspicion is necessary. Despite recent advances, in-hospital mortality rates remain high. Our data support the need for continued improvement in prevention, diagnosis, and management of acute aortic dissection.
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            2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.

            Loren Hiratzka, George L. Bakris, Joshua A Beckman … (2010)
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              Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks.

              John Elefteriades (2002)
              The natural history of thoracic aortic aneurysm is incompletely understood. Over the last 10 years, at Yale University we have maintained a large computerized database of patients with thoracic aortic aneurysms and dissections. Analysis of this database has permitted insight into fundamental issues of natural behavior of the aorta and development of criteria for surgical intervention. Specialized statistical methods were applied to the prospectively accumulated database of 1600 patients with thoracic aneurysm and dissection, which includes 3000 serial imaging studies and 3000 patient years of follow-up. Growth rate: the aneurysmal thoracic aorta grows at an average rate of 0.10 cm per year (0.07 for ascending and 0.19 for descending). Critical sizes: hinge points for natural complications of aortic aneurysm (rupture or dissection) were found at 6.0 cm for the ascending aorta and 7.0 cm for the descending. By the time a patient achieved these critical dimensions the likelihood of rupture or dissection was 31% for the ascending and 43% for the descending aorta. Yearly event rates: a patient with an aorta that has reached 6 cm maximal diameter faces the following yearly rates of devastating adverse events: rupture (3.6%), dissection (3.7%), death (10.8%), rupture, dissection, or death (14.1%). Surgical risks: risk of death from aortic surgery for thoracic aortic aneurysm was 2.5% for the ascending and arch and 8% for the descending and thoracoabdominal aorta. Genetic analysis: family pedigrees confirm that 21% of probands with thoracic aortic aneurysm have first-order family members with arterial aneurysm. In risk/benefit analysis the accumulated data strongly support a policy of preemptive surgical extirpation of the asymptomatic aneurysmal thoracic aorta to prevent rupture and dissection. We recommend intervention for the ascending aorta at 5.5 cm and for the descending aorta at 6.5 cm. For Marfan's disease or familial thoracic aortic aneurysm, we recommend earlier intervention at 5.0 cm for the ascending and 6.0 cm for the descending aorta. Symptomatic aneurysms must be resected regardless of size. Family members should be evaluated.
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                Author and article information

                Contributors
                Ernesto Di Cesare
                Journal
                Journal ID (nlm-ta): Open Med (Wars)
                Journal ID (iso-abbrev): Open Med (Wars)
                Journal ID (publisher-id): med
                Journal ID (pmc): med
                Title: Open Medicine
                Publisher: De Gruyter Open
                ISSN (Electronic): 2391-5463
                Publication date Collection: 2016
                Publication date (Electronic): 23 June 2016
                Volume: 11
                Issue: 1
                Pages: 143-151
                Affiliations
                [1] 1Dipartimento di Scienze Cliniche Applicate e biotecnologiche, Università degli studi di L’Aquila, Via Vetoio 1, 67100 L’Aquila, Italy, Tel 00390862368306, Fax 00390862368797
                [2] 2Dipartimento di Scienze Cliniche Applicate e biotecno-logiche Università degli studi di L’Aquila, Italy
                [3] 3Dipartimento di Diagnostica per Immagini Universi-tà Tor Vergata Roma, Italy
                [4] 4Dipartimento di medicina e Scienza della salute, Universita del Molise, Campobasso, Italy
                Article
                Publisher ID: med-2016-0028
                DOI: 10.1515/med-2016-0028
                PMC ID: 5329815
                PubMed ID: 28352783
                SO-VID: 37033ddc-f6d0-4052-806c-a44d32efd903
                Copyright © © 2016 Ernesto Di Cesare et al.
                License:

                This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

                History
                Date received : 2 January 2016
                Date accepted : 7 March 2016
                Page count
                Pages: 9
                Categories
                Subject: Special Issue on Italian Society for the Study of Vascular Anomalies

                Keywords: thoracic aorta, ct,thoracic aorta, mri,aortic diseases
                Data availability:
                Keywords: thoracic aorta, ct, thoracic aorta, mri, aortic diseases

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