Skip to main content

Advertisement

SpringerLink
Log in

Role of Computed Tomography in Assessment of the Thoracic Aorta

  • Imaging (J Hung, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Thoracic aortic disease is increasing in prevalence and can result in serious morbidity and mortality. Computed tomography (CT) angiography is an important imaging modality for assessment of thoracic aortic pathology due to wide availability, rapid acquisition, reproducibility, superior spatial and temporal resolution, and capability for 3D image post-processing. CT is the preferred imaging modality in the acute setting to rapidly identify patients with acute aortic syndromes including dissection, intramural hematoma, and penetrating aortic ulcer. CT also plays an important role in post-procedural surveillance of the thoracic aorta for early and late complications from open or endovascular repair. Incidentally detected thoracic aortic aneurysms and congenital aortic anomalies such as coarctation can be thoroughly characterized and followed over time for potential elective intervention. Drawbacks of CT include exposure to radiation and iodinated contrast media; however, recent strategies for dose reduction and contrast optimization have significantly decreased these risks. Electrocardiogram (ECG)-gated CT angiography provides additional information about the aortic root, coronary arteries, and other cardiac structures without motion artifacts.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Svensson LG, Rodriguez ER. Aortic organ disease epidemic, and why do balloons pop? In Circulation. United States:2005 p. 1082–4.

  2. Hiratzka LF et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: Executive summary: 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. Anesth Analg. 2010;111(2):279–315. Current multi-society guidelines regarding the management of various forms of thoracic aortic pathology, including recommendations for imaging surveillance and elective repair.

    Article  PubMed  Google Scholar 

  3. Tatli S, Yucel EK, Lipton MJ. CT and MR imaging of the thoracic aorta: current techniques and clinical applications. Radiol Clin N Am. 2004;42(3):565–85. vi.

    Article  PubMed  Google Scholar 

  4. Kurra V et al. Extent of thoracic aortic atheroma burden and long-term mortality after cardiothoracic surgery: a computed tomography study. J Am Coll Cardiol Img. 2010;3(10):1020–9.

    Article  Google Scholar 

  5. Rogers IS et al. Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study). Am J Cardiol. 2013;111(10):1510–6. Overview from the Framingham study of variation in aortic size measurements on CT based on patient-specific characteristics.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Davies RR, et al. Novel measurement of relative aortic size predicts rupture of thoracic aortic aneurysms, In Ann Thorac Surg. Netherlands. 2006 p. 169–77.

  7. Goldstein SA et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2015;28(2):119–82. Recent multi-society consensus paper on appropriate use of various imaging modalities for patients with thoracic aortic disease, including echocardiography, CT, and MR.

    Article  PubMed  Google Scholar 

  8. Deak Z et al. Endoleak and in-stent thrombus detection with CT angiography in a thoracic aortic aneurysm phantom at different tube energies using filtered back projection and iterative algorithms. Radiology. 2014;271(2):574–84.

    Article  PubMed  Google Scholar 

  9. Sousa PJ et al. Marfan syndrome with ascending aortic aneurysm: value of cardiac computed tomography. Rev Port Cardiol. 2013;32(1):59–62.

    PubMed  Google Scholar 

  10. Lemaire SA et al. Genome-wide association study identifies a susceptibility locus for thoracic aortic aneurysms and aortic dissections spanning FBN1 at 15q21.1. Nat Genet. 2011;43(10):996–1000.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Chu LC et al. CT angiographic evaluation of genetic vascular disease: role in detection, staging, and management of complex vascular pathologic conditions. AJR Am J Roentgenol. 2014;202(5):1120–9.

    Article  PubMed  Google Scholar 

  12. Sundt TM. Sound arguments, true premises, and valid conclusions. J Thorac Cardiovasc Surg. 2014;148(5):2070–1.

    Article  PubMed  Google Scholar 

  13. Stein PD, YA, Matta F, Sostman HD. 64-slice CT for diagnosis of coronary artery disease: a systematic review. Am J Med. 2008.

  14. Omura A et al. Early and late results of graft replacement for dissecting aneurysm of thoracoabdominal aorta in patients with Marfan syndrome. Ann Thorac Surg. 2012;94(3):759–65.

    Article  PubMed  Google Scholar 

  15. Ueda T et al. A pictorial review of acute aortic syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography. Insights Imaging. 2012;3(6):561–71.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Coady MA et al. Surgical management of descending thoracic aortic disease: open and endovascular approaches: a scientific statement from the American Heart Association. Circulation. 2010;121(25):2780–804. Statement paper from the American Heart Association discussing options for open and percutaneous management and repair of thoracic aortic pathology.

    Article  PubMed  Google Scholar 

  17. Booher AM et al. The IRAD classification system for characterizing survival after aortic dissection. Am J Med. 2013;126(8):730 e19–24.

    Article  Google Scholar 

  18. Evangelista A et al. Long-term outcome of aortic dissection with patent false lumen: predictive role of entry tear size and location. Circulation. 2012;125(25):3133–41.

    Article  PubMed  Google Scholar 

  19. Nienaber CA et al. Endovascular repair of type B aortic dissection: long-term results of the randomized investigation of stent grafts in aortic dissection trial. Circ Cardiovasc Interv. 2013;6(4):407–16.

    Article  CAS  PubMed  Google Scholar 

  20. Alomari IB et al. Aortic intramural hematoma and its complications. Circulation. 2014;129(6):711–6.

    Article  PubMed  Google Scholar 

  21. Estrera AL et al. Early and late outcomes of acute type A aortic dissection with intramural hematoma. J Thorac Cardiovasc Surg. 2015;149(1):137–42.

    Article  PubMed  Google Scholar 

  22. Lavingia KS et al. Aortic remodeling after thoracic endovascular aortic repair for intramural hematoma. J Vasc Surg. 2014;60(4):929–35. discussion 935–6.

    Article  PubMed  Google Scholar 

  23. Shin JH et al. CT imaging findings and their relevance to the clinical outcomes after stent graft repair of penetrating aortic ulcers: six-year, single-center experience. Cardiovasc Intervent Radiol. 2012;35(6):1301–7.

    Article  PubMed  Google Scholar 

  24. Verhoeven EL, et al. Ten-year experience with endovascular repair of thoracoabdominal aortic aneurysms: results from 166 consecutive patients. Eur J Vasc Endovasc Surg. 2015.

  25. Vallabhajosyula P, et al. Endovascular repair of the ascending aorta in patients at high risk for open repair. J Thorac Cardiovasc Surg. 2014.

  26. Lu Q et al. Endovascular repair of ascending aortic dissection: a novel treatment option for patients judged unfit for direct surgical repair. J Am Coll Cardiol. 2013;61(18):1917–24. Ascending aortic dissection has not traditionally been considered candidate for endovascular repair; this 2013 paper covers details of the approach and appropriate patients.

    Article  PubMed  Google Scholar 

  27. Wyss TR et al. The influence of thrombus, calcification, angulation, and tortuosity of attachment sites on the time to the first graft-related complication after endovascular aneurysm repair. J Vasc Surg. 2011;54(4):965–71.

    Article  PubMed  Google Scholar 

  28. Flors L et al. Imaging follow-up of endovascular repair of type B aortic dissection with dual-source, dual-energy CT and late delayed-phase scans. J Vasc Interv Radiol. 2014;25(3):435–42.

    Article  PubMed  Google Scholar 

  29. Szeto WY et al. Reintervention for endograft failures after thoracic endovascular aortic repair. J Thorac Cardiovasc Surg. 2013;145(3 Suppl):S165–70.

    Article  PubMed  Google Scholar 

  30. Lombardi JV et al. Prospective multicenter clinical trial (STABLE) on the endovascular treatment of complicated type B aortic dissection using a composite device design. J Vasc Surg. 2012;55(3):629–640 e2.

    Article  PubMed  Google Scholar 

  31. Lombardi JV et al. Aortic remodeling after endovascular treatment of complicated type B aortic dissection with the use of a composite device design. J Vasc Surg. 2014;59(6):1544–54.

    Article  PubMed  Google Scholar 

  32. Lindsay AC et al. Multidetector computed tomography of congenital aortic abnormalities. Int J Cardiol. 2014;172(3):537–47.

    Article  PubMed  Google Scholar 

  33. Kilner PJ. Imaging congenital heart disease in adults. Br J Radiol. 2011. 84 Spec No 3: p. S258–68.

  34. Budoff MJ, Shittu A, Roy S. Use of cardiovascular computed tomography in the diagnosis and management of coarctation of the aorta. J Thorac Cardiovasc Surg. 2013;146(1):229–32.

    Article  PubMed  Google Scholar 

  35. Ostovan MA et al. Procedural outcome and one year follow up of patients undergoing endovascular stenting for coarctation of aorta: a single center study. J Cardiovasc Thorac Res. 2014;6(2):117–21.

    PubMed Central  PubMed  Google Scholar 

  36. Darabian S et al. Use of noninvasive imaging in the evaluation of coarctation of aorta. J Comput Assist Tomogr. 2013;37(1):75–8.

    Article  PubMed  Google Scholar 

  37. Preventza O et al. Coarctation-associated aneurysms: a localized disease or diffuse aortopathy. Ann Thorac Surg. 2013;95(6):1961–7. discussion 1967.

    Article  PubMed  Google Scholar 

  38. Prakash SK et al. A roadmap to investigate the genetic basis of bicuspid aortic valve and its complications: insights from the International BAVCon (Bicuspid Aortic Valve Consortium). J Am Coll Cardiol. 2014;64(8):832–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Detaint D et al. Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative study with Marfan syndrome and degenerative aortopathy. Heart. 2014;100(2):126–34.

    Article  PubMed  Google Scholar 

  40. Broberg CS, Therrien J. Understanding and treating aortopathy in bicuspid aortic valve. Trends Cardiovasc Med. 2014.

  41. Shin HJ, et al. Characteristics of aortic valve dysfunction and ascending aorta dimensions according to bicuspid aortic valve morphology. Eur Radiol. 2015.

  42. Kang JW et al. Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography. J Am Coll Cardiol Img. 2013;6(2):150–61.

    Article  Google Scholar 

  43. Jackson V et al. Aortic dimensions in patients with bicuspid and tricuspid aortic valves. J Thorac Cardiovasc Surg. 2013;146(3):605–10.

    Article  PubMed  Google Scholar 

  44. Hardikar AA, Marwick TH. Surgical thresholds for bicuspid aortic valve associated aortopathy. J Am Coll Cardiol Img. 2013;6(12):1311–20. Imaging-oriented approach to managing patients with bicuspid aortic valve and aortopathy for evaluation of potential elective repair.

    Article  Google Scholar 

  45. Fedak PW, Verma S. Bicuspid aortopathy and the development of individualized resection strategies. J Thorac Cardiovasc Surg. 2014;148(5):2080–1.

    Article  PubMed  Google Scholar 

  46. Roman MJ et al. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol. 1989;64(8):507–12.

    Article  CAS  PubMed  Google Scholar 

  47. Lin FY et al. Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease. J Cardiovasc Comput Tomogr. 2008;2(5):298–308.

    Article  PubMed  Google Scholar 

  48. Johnston KW et al. Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg. 1991;13(3):452–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Nandini M. Meyersohn, Khristine Ghemigian, Michael D. Shapiro, and Shimoli V. Shah declare that they have competing interests.

Brian B. Ghoshhajra reports consulting fees from Siemens Healthcare USA.

Maros Ferencik received support from the American Heart Association (13FTF16450001).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Radiology, Cardiac MR PET CT Program, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA

    Nandini M. Meyersohn MD, Khristine Ghemigian BA, MHS, Brian B. Ghoshhajra MD, MBA & Maros Ferencik MD, PhD

  2. Knight Cardiovascular Institute, Oregon Health and Science University, Mail Code UHN62, 3180 SW Sam Jackson Park Rd, Portland, OR, 97239, USA

    Michael D. Shapiro DO, Shimoli V. Shah MD & Maros Ferencik MD, PhD

Authors
  1. Nandini M. Meyersohn MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Khristine Ghemigian BA, MHS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael D. Shapiro DO
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shimoli V. Shah MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Brian B. Ghoshhajra MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maros Ferencik MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maros Ferencik MD, PhD.

Additional information

This article is part of the Topical Collection on Imaging

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meyersohn, N.M., Ghemigian, K., Shapiro, M.D. et al. Role of Computed Tomography in Assessment of the Thoracic Aorta. Curr Treat Options Cardio Med 17, 35 (2015). https://doi.org/10.1007/s11936-015-0395-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-015-0395-9

Keywords

Search

Navigation