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The current and future role of imaging of thoracic aortic disease: a North American society for cardiovascular imaging commentary on the 2022 AHA/ACC guidelines for the diagnosis and management of aortic disease

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Abstract

The 2022 AHA/ACC Guidelines for the Diagnosis and Management of Aortic Disease introduced important updates for managing thoracic aorta aortic disease (TAD). In particular, the Guidelines underscore multimodality imaging's role in diagnosis, risk assessment, and monitoring of patients with TAD. This commentary aims to distill key imaging aspects from the Guidelines to provide a concise reference for the cardiovascular imaging community. Primary areas of focus include: (1) The importance of imagers in the multidisciplinary TAD care team, (2) Appropriate imaging techniques along with their strengths and weaknesses, (3) Aortic measurement methods and how aortic size and growth should contribute to TAD risk assessment, (4) Imaging evaluation of acute aortic syndrome. We have also highlighted several areas of ongoing uncertainty and confusion, specifically related to aortic measurement techniques and descriptive terminology. Finally, a perspective on the future of TAD imaging is discussed with a focus on advanced imaging tools and techniques as well as the potential role of artificial intelligence.

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Funding

Bradley D. Allen: American Heart Association (20CDA35310687), American Roentgen Ray Society.

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Authors and Affiliations

  1. Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA

    Aws Hamid

  2. Division of Pediatric Cardiology, Children’s Hospital of San Antonio, Baylor College of Medicine, San Antonio, TX, USA

    Monesha Gupta

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Prabhakar Shantha Rajiah

  4. Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA

    Suhny Abbara

  5. Department of Medical Imaging, University Medical Imaging Toronto, University of Toronto, Toronto, ON, Canada

    Kate Hanneman

  6. Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave Suite 1600, Chicago, IL, 60611, USA

    Bradley D. Allen

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Contributions

All authors contributed to manuscript conception. A.H., M.G., P.S.R., B.D.A. drafted and critically revised the manuscript. S.A. and K.H. critically revised the manuscript. All authors approved the final version of the manuscript.

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Correspondence to Bradley D. Allen.

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Conflict of interest

Aws Hamid has no relevant financial or non-financial interests to disclose. Monesha Gupta has no relevant financial or non-financial interests to disclose. Prabhakar Shantha Rajiah has no relevant financial or non-financial interests to disclose. Suhny Abbara, MD, FACR. MSCCT: Royalties, Elsevier. Kate Hanneman: Honoria Sanofi, Amicus, Medscape, MRI Online. Bradley D. Allen: Speaking fees, Circle Cardiovascular Imaging; Research Support, Guerbet; Co-Founder and Shareholder, Third Coast Dynamics, Inc.

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Hamid, A., Gupta, M., Rajiah, P.S. et al. The current and future role of imaging of thoracic aortic disease: a North American society for cardiovascular imaging commentary on the 2022 AHA/ACC guidelines for the diagnosis and management of aortic disease. Int J Cardiovasc Imaging 40, 5–14 (2024). https://doi.org/10.1007/s10554-023-02964-1

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