Skip to main content
SpringerLink
Log in

Imaging of Aortic Dissection: CT, MRI, and Angiography

  • Chapter
  • First Online:
Aortic Dissection and Acute Aortic Syndromes

  • 1522 Accesses

Abstract

Imaging is integral to the initial diagnosis of patients with a suspected aortic dissection; and should consist of multi-detector computed tomography (MDCT), transesophageal echocardiogram (TEE) or magnetic resonance imaging (MRI) based on the patient stability and institution capabilities. In this chapter we review MDCT, MRI and angiography in the setting of acute aortic dissections in regards to protocol considerations, proper measurement techniques and features which should be included in diagnostic reports due to their implications on immediate management and prognosis.

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

Access this chapter

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Hiratzka LF, Bakris GL, Beckman JA, 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. 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. J Am Coll Cardiol. 2010;55(14):e27–e129.

    Article  Google Scholar 

  2. Erbel R, Aboyans V, Boileau C, et al. 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.

    Article  Google Scholar 

  3. Vardhanabhuti V, Nicol E, Morgan-Hughes G, et al. Recommendations for accurate CT diagnosis of suspected acute aortic syndrome (AAS)—on behalf of the British Society of Cardiovascular Imaging (BSCI)/British Society of Cardiovascular CT (BSCCT). Br J Radiol. 2016;89(1061):20150705.

    Article  Google Scholar 

  4. Baliga RR, Nienaber CA, Bossone E, et al. The role of imaging in aortic dissection and related syndromes. JACC Cardiovasc Imaging. 2014;7(4):406–24.

    Article  Google Scholar 

  5. Fattori R, Cao P, De Rango P, et al. Interdisciplinary expert consensus document on management of type B aortic dissection. J Am Coll Cardiol. 2013;61(16):1661–78.

    Article  Google Scholar 

  6. Grabenwoger M, Alfonso F, Bachet J, et al. Thoracic Endovascular Aortic Repair (TEVAR) for the treatment of aortic diseases: a position statement from the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2012;33(13):1558–63.

    Article  Google Scholar 

  7. Goldstein SA, Evangelista A, Abbara S, 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.

    Article  Google Scholar 

  8. Raymond CE, Aggarwal B, Schoenhagen P, et al. Prevalence and factors associated with false positive suspicion of acute aortic syndrome: experience in a patient population transferred to a specialized aortic treatment center. Cardiovasc Diagn Ther. 2013;3(4):196–204.

    PubMed  PubMed Central  Google Scholar 

  9. Shiga T, Wajima Z, Apfel CC, Inoue T, Ohe Y. Diagnostic accuracy of transesophageal echocardiography, helical computed tomography, and magnetic resonance imaging for suspected thoracic aortic dissection: systematic review and meta-analysis. Arch Intern Med. 2006;166(13):1350–6.

    Article  Google Scholar 

  10. Valente T, Rossi G, Lassandro F, et al. MDCT evaluation of acute aortic syndrome (AAS). Br J Radiol. 2016;89(1061):20150825.

    Article  Google Scholar 

  11. Expert Panels on Vascular Imaging and Interventional Radiology, Bonci G, et al. ACR appropriateness criteria((R)) thoracic aorta interventional planning and follow-up. J Am Coll Radiol. 2017;14(11S):S570–83.

    Google Scholar 

  12. Halpern EJ. Triple-rule-out CT angiography for evaluation of acute chest pain and possible acute coronary syndrome. Radiology. 2009;252(2):332–45.

    Article  Google Scholar 

  13. Burris AC 2nd, Boura JA, Raff GL, Chinnaiyan KM. Triple rule out versus coronary CT angiography in patients with acute chest pain: results from the ACIC consortium. JACC Cardiovasc Imaging. 2015;8(7):817–25.

    Article  Google Scholar 

  14. McMahon MA, Squirrell CA. Multidetector CT of aortic dissection: a pictorial review. Radiographics. 2010;30(2):445–60.

    Article  Google Scholar 

  15. Swee W, Dake MD. Endovascular management of thoracic dissections. Circulation. 2008;117(11):1460–73.

    Article  Google Scholar 

  16. Tsai TT, Evangelista A, Nienaber CA, et al. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357(4):349–59.

    Article  CAS  Google Scholar 

  17. Hirst AE Jr, Johns VJ Jr, Kime SW Jr. Dissecting aneurysm of the aorta: a review of 505 cases. Medicine (Baltimore). 1958;37(3):217–79.

    Article  Google Scholar 

  18. Angeloni E, Benedetto U, Takkenberg JJ, et al. Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: a meta-analysis of 5100 patients. J Thorac Cardiovasc Surg. 2014;147(1):60–7.

    Article  Google Scholar 

  19. Movsowitz HD, Levine RA, Hilgenberg AD, Isselbacher EM. Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol. 2000;36(3):884–90.

    Article  CAS  Google Scholar 

  20. Castaner E, Andreu M, Gallardo X, Mata JM, Cabezuelo MA, Pallardo Y. CT in nontraumatic acute thoracic aortic disease: typical and atypical features and complications. Radiographics. 2003;23 Spec No:S93–110.

    Article  Google Scholar 

  21. Williams DM, Lee DY, Hamilton BH, et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology. 1997;203(1):37–44.

    Article  CAS  Google Scholar 

  22. Lichtenberger JP 3rd, Franco DF, Kim JS, Carter BW. MR imaging of thoracic aortic disease. Top Magn Reson Imaging. 2018;27(2):95–102.

    Article  Google Scholar 

  23. Amano Y, Takahama K, Kumita S. Non-contrast-enhanced MR angiography of the thoracic aorta using cardiac and navigator-gated magnetization-prepared three-dimensional steady-state free precession. J Magn Reson Imaging. 2008;27(3):504–9.

    Article  Google Scholar 

  24. Cigarroa JE, Isselbacher EM, DeSanctis RW, Eagle KA. Diagnostic imaging in the evaluation of suspected aortic dissection. Old standards and new directions. N Engl J Med. 1993;328(1):35–43.

    Article  CAS  Google Scholar 

  25. Kirschner LP, Twigg HL, Conrad PW, Hufnagel C. Retrograde catheter aortography in dissecting aortic aneurysms. Am J Roentgenol Radium Therapy, Nucl Med. 1968;102(2):349–53.

    Article  CAS  Google Scholar 

  26. Erbel R, Engberding R, Daniel W, Roelandt J, Visser C, Rennollet H. Echocardiography in diagnosis of aortic dissection. Lancet. 1989;1(8636):457–61.

    Article  CAS  Google Scholar 

  27. Bansal RC, Chandrasekaran K, Ayala K, Smith DC. Frequency and explanation of false negative diagnosis of aortic dissection by aortography and transesophageal echocardiography. J Am Coll Cardiol. 1995;25(6):1393–401.

    Article  CAS  Google Scholar 

  28. Earnest F, Muhm JR, Sheedy PF 2nd. Roentgenographic findings in thoracic aortic dissection. Mayo Clin Proc. 1979;54(1):43–50.

    PubMed  Google Scholar 

  29. Shuford WH, Sybers RG, Weens HS. Problems in the aortographic diagnosis of dissecting aneurysm of the aorta. N Engl J Med. 1969;280(5):225–31.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA

    Albree Tower-Rader, Lars G. Svensson & Venu Menon

Authors
  1. Albree Tower-Rader
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lars G. Svensson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Venu Menon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Venu Menon .

Editor information

Editors and Affiliations

  1. Rhode Island Hospital, Brown University, Providence, RI, USA

    Frank W. Sellke

  2. Department of Surgery, Baylor College of Medicine, Houston, USA

    Joseph S. Coselli

  3. Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Thoralf M. Sundt

  4. Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA, USA

    Joseph E. Bavaria

  5. Thoracic Cardiothoracic Surgery, Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA

    Neel R. Sodha

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Tower-Rader, A., Svensson, L.G., Menon, V. (2021). Imaging of Aortic Dissection: CT, MRI, and Angiography. In: Sellke, F.W., Coselli, J.S., Sundt, T.M., Bavaria, J.E., Sodha, N.R. (eds) Aortic Dissection and Acute Aortic Syndromes. Springer, Cham. https://doi.org/10.1007/978-3-030-66668-2_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-66668-2_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-66667-5

  • Online ISBN: 978-3-030-66668-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation