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Imaging of the Aorta

  • Raymond ChungEmail author
Chapter

Abstract

Acute aortic pathologies often present with similar clinical symptoms, and thereby instigation of the appropriate management algorithm is heavily reliant on radiological findings. With the advent of multidetector CT (MDCT), rapid, replicable, noninvasive diagnostic imaging can be acquired. MRI and echocardiography can provide additional functional data without ionizing radiation but are hampered by their speed, availability, and operator dependence. In this chapter, imaging acquisition, potential pitfalls, and aortic imaging in the form of radiography and MDCT are discussed.

References

  1. 1.
    von Kodolitsch Y, Nienaber CA, Dieckmann C, Schwartz AG, Hofmann T, Brekenfeld C, Nicolas V, Berger J, Meinertz T. Chest radiography for the diagnosis of acute aortic syndrome. Am J Med. 2004;116(2):73–7.CrossRefGoogle Scholar
  2. 2.
    Chawla A, Rajendran S, Yung WH, Babu SB, Peh WC. Chest radiography in acute aortic syndrome: pearls and pitfalls. Emerg Radiol. 2016;23(4):405–12.PubMedCrossRefGoogle Scholar
  3. 3.
    Hunter TB, Taljanovic MS, Tsau PH, Berger WG, Standen JR. Medical devices of the chest. Radiographics. 2004;24(6):1725–46.PubMedCrossRefGoogle Scholar
  4. 4.
    Mundy J, Stickley M, Venkatesh B, Coucher J, Foot CL. The imaginary line method is not reliable for identification of prosthetic heart valves on AP chest radiographs. Crit Care Resusc. 2006;8(1):15.PubMedGoogle Scholar
  5. 5.
    Gross BH, Shirazi KK, Slater AD. Differentiation of aortic and mitral valve prostheses based on postoperative frontal chest radiographs. Radiology. 1983;149(2):389–91.PubMedCrossRefGoogle Scholar
  6. 6.
    Jakanani GC, Adair W. Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol. 2010;65(6):481–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Layton KF, Kallmes DF, Cloft HJ, Lindell EP, Cox VS. Bovine aortic arch variant in humans: clarification of a common misnomer. Am J Neuroradiol. 2006;27(7):1541–2.PubMedGoogle Scholar
  8. 8.
    Kau T, Sinzig M, Gasser J, Lesnik G, Rabitsch E, Celedin S, Eicher W, Illiasch H, Hausegger KA. Aortic development and anomalies. Semin Interv Radiol. 2007;24(2):141.CrossRefGoogle Scholar
  9. 9.
    Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ, ESC Committee for Practice Guidelines. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873–926.CrossRefGoogle Scholar
  10. 10.
    Hager A, Kaemmerer H, Rapp-Bernhardt U, Blücher S, Rapp K, Bernhardt TM, Galanski M, Hess J. Diameters of the thoracic aorta throughout life as measured with helical computed tomography. J Thorac Cardiovasc Surg. 2002;123(6):1060–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Wolak A, Gransar H, Thomson LE, Friedman JD, Hachamovitch R, Gutstein A, Shaw LJ, Polk D, Wong ND, Saouaf R, Hayes SW. Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area. J Am Coll Cardiol Cardiovasc Imaging. 2008;1(2):200–9.CrossRefGoogle Scholar
  12. 12.
    Lee SH, Lee W, Choi HJ, Kim DJ, Park EA, Chung JW, Park JH. Measurement of the aortic diameter in the asymptomatic Korean population: assessment with multidetector CT. J Korean Soc Radiol. 2013;69(2):105–12.CrossRefGoogle Scholar
  13. 13.
    Hanneman K, Newman B, Chan F. Congenital variants and anomalies of the aortic arch. Radiographics. 2016;37(1):32–51.PubMedCrossRefGoogle Scholar
  14. 14.
    Cotrufo M, Agozzino L, De MF, Della AC, Santo De LS, Di GB, Esposito S, Nappi G. Aortic valve dysfunction and dilated ascending aorta. A complex and controversial association. Ital Heart J. 2003;4(9):589–95.PubMedGoogle Scholar
  15. 15.
    Bolger AF. Aortic intramural haematoma. Heart. 2008;94(12):1670–4.PubMedCrossRefGoogle Scholar
  16. 16.
    Castañer E, Andreu M, Gallardo X, Mata JM, Cabezuelo MÁ, Pallardó Y. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications. Radiographics. 2003;23(Suppl 1):S93–110.PubMedCrossRefGoogle Scholar
  17. 17.
    Ganaha F, Miller DC, Sugimoto K, Do YS, Minamiguchi H, Saito H, Mitchell RS, Dake MD. Prognosis of aortic intramural hematoma with and without penetrating atherosclerotic ulcer: a clinical and radiological analysis. Circulation. 2002;106(3):342–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Valente T, Rossi G, Lassandro F, Rea G, Marino M, Muto M, Molino A, Scaglione M. MDCT evaluation of acute aortic syndrome (AAS). Br J Radiol. 2016;89(1061):20150825.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Rubin GD. Helical CT angiography of the thoracic aorta. J Thorac Imaging. 1997;12(2):128–49.PubMedCrossRefGoogle Scholar
  20. 20.
    Kitai T, Kaji S, Yamamuro A, Tani T, Kinoshita M, Ehara N, Kobori A, Kita T, Furukawa Y. Impact of new development of ulcer-like projection on clinical outcomes in patients with type B aortic dissection with closed and thrombosed false lumen. Circulation. 2010;122(11 suppl 1):S74–80.PubMedCrossRefGoogle Scholar
  21. 21.
    Nagpal P, Khandelwal A, Saboo SS, Bathla G, Steigner ML, Rybicki FJ. Modern imaging techniques: applications in the management of acute aortic pathologies. Postgrad Med J. 2015;91:449–62.PubMedCrossRefGoogle Scholar
  22. 22.
    Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA. Acute aortic dissection and intramural hematoma: a systematic review. JAMA. 2016;316(7):754–63.CrossRefGoogle Scholar
  23. 23.
    Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10(3):237–47.PubMedCrossRefGoogle Scholar
  24. 24.
    Debakey ME. Surgical management of dissecting aneurysms of the aorta. J Thorac Cardiovasc Surg. 1965;49:130–49.PubMedGoogle Scholar
  25. 25.
    Jones MR, Reid JH. Emergency chest radiology: thoracic aortic disease and pulmonary embolism. Imaging. 2006;18(3):122–38.CrossRefGoogle Scholar
  26. 26.
    Kapoor V, Ferris JV, Fuhrman CR. Intimomedial rupture: a new CT finding to distinguish true from false lumen in aortic dissection. Am J Roentgenol. 2004;183(1):109–12.CrossRefGoogle Scholar
  27. 27.
    McMahon MA, Squirrell CA. Multidetector CT of aortic dissection: a pictorial review. Radiographics. 2010;30(2):445–60.PubMedCrossRefGoogle Scholar
  28. 28.
    Willoteaux S, Lions C, Gaxotte V, Negaiwi Z, Beregi JP. Imaging of aortic dissection by helical computed tomography (CT). Eur Radiol. 2004;14(11):1999–2008.PubMedCrossRefGoogle Scholar
  29. 29.
    Agarwal PP, Chughtai A, Matzinger FR, Kazerooni EA. Multidetector CT of thoracic aortic aneurysms. Radiographics. 2009;29(2):537–52.PubMedCrossRefGoogle Scholar
  30. 30.
    Ahmed MZ, Ling L, Ettles DF. Common and uncommon CT findings in rupture and impending rupture of abdominal aortic aneurysms. Clin Radiol. 2013;68(9):962–71.PubMedCrossRefGoogle Scholar
  31. 31.
    Schwartz SA, Taljanovic MS, Smyth S, O’Brien MJ, Rogers LF. CT findings of rupture, impending rupture, and contained rupture of abdominal aortic aneurysms. Am J Roentgenol. 2007;188(1):W57–62.CrossRefGoogle Scholar
  32. 32.
    Parodi J, Berguer R, Carrascosa P, Khanafer K, Capunay C, Wizauer E. Sources of error in the measurement of aortic diameter in computed tomography scans. J Vasc Surg. 2014;59(1):74–9.PubMedCrossRefGoogle Scholar
  33. 33.
    Sueyoshi E, Sakamoto I, Hayashi K. Aortic aneurysms in patients with Takayasu’s arteritis: CT evaluation. Am J Roentgenol. 2000;175(6):1727–33.CrossRefGoogle Scholar
  34. 34.
    Restrepo CS, Ocazionez D, Suri R, Vargas D. Aortitis: imaging spectrum of the infectious and inflammatory conditions of the aorta. Radiographics. 2011;31(2):435–51.PubMedCrossRefGoogle Scholar
  35. 35.
    Hayashi H, Katayama N, Takagi R, Matsuoka Y, Matsunaga N. CT analysis of vascular wall during the active phase of Takayasu’s aortitis [abstr]. Eur Radiol. 1991;1:S239.Google Scholar
  36. 36.
    Inoue D, Zen Y, Abo H, Gabata T, Demachi H, Yoshikawa J, Miyayama S, Nakanuma Y, Matsui O. Immunoglobulin G4–related periaortitis and periarteritis: CT findings in 17 patients. Radiology. 2011;261(2):625–33.PubMedCrossRefGoogle Scholar
  37. 37.
    Vlahos I, Godoy MC, Naidich DP. Dual-energy computed tomography imaging of the aorta. J Thorac Imaging. 2010;25(4):289–300.PubMedCrossRefGoogle Scholar
  38. 38.
    Maturen KE, Kleaveland PA, Kaza RK, Liu PS, Quint LE, Khalatbari SH, Platt JF. Aortic endograft surveillance: use of fast-switch kVp dual-energy computed tomography with virtual noncontrast imaging. J Comput Assist Tomogr. 2011;35(6):742–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Vlahos I, Chung R, Nair A, Morgan R. Dual-energy CT: vascular applications. Am J Roentgenol. 2012;199(5 Supplement):S87–97.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Diagnostic RadiologyKhoo Teck Puat HospitalSingaporeSingapore

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