Pictorial Review

Insights into Imaging

, Volume 3, Issue 6, pp 561-571

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

A pictorial review of acute aortic syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography

  • Takuya UedaAffiliated withDepartment of Radiology, St. Luke’s International Hospital Email author 
  • , Anne ChinAffiliated withDepartment of Radiology, Centre Hospitalier de L’Univeristé de Montréal
  • , Ivan PetrovitchAffiliated withNorthern Virginia Radiology Consultants, PLLC
  • , Dominik FleischmannAffiliated withDepartment of Radiology, Stanford University School of Medicine



The term "acute aortic syndrome" (AAS) encompasses a spectrum of life-threatening conditions characterized by acute aortic pain. AAS traditionally embraces three abnormalities including classic aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. Although the underlying etiologies and conditions predisposing to AAS are diverse, the clinical features are indistinguishable.


Multidetector-row computed tomography (CT) with electrocardiographic gating (ECG-gated MDCT) has greatly improved imaging of acute thoracic aortic diseases by virtually eliminating pulsation artifacts transmitted from cardiac motion and reveals subtle aortic abnormalities, which have been difficult to recognize by conventional non-gated CT.


While these advances in imaging technology provide additional discriminating features of acute aortic diseases, they also reveal a range of overlapping features of these life-threatening conditions that not uncommonly are dynamic and evolving. These overlapping and transitional features may be a major source of misunderstanding, confusion, and controversy for diseases that cause AAS.


In this pictorial review, we describe the discriminating and typical imaging features as revealed by modern ECG-gated MDCT angiography. In addition to the discriminating features, recognition of the overlapping and transitional features in AAS will allow a more comprehensive understanding of their underlying pathophysiologic conditions and their natural history, and may improve therapeutic management.

Main Messages

The superior visualization of ECG-gated CTA improves the diagnostic accuracy of acute aortic syndrome.

ECG-gated CTA provides discriminating features of underlying pathophysiologic conditions of AAS.

Also, recognition of the overlapping features in AAS will allow a more comprehensive understanding.


Aortic diseases Tomography X-ray computed Aneurysm Aortic dissection Aortic aneurysm