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Wu MY, Bang TJ, Restauri N, Chawla A, Khawaja RDA, Vargas D. Imaging Acute Aortic Syndromes. Semin Roentgenol 2022; 57:335-344. [DOI: 10.1053/j.ro.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/11/2022]
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2
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Significance of systolic-phase imaging on full-phase ECG-gated CT angiography to detect intimal tears in aortic dissection. Heart Vessels 2022; 37:1947-1956. [PMID: 35569067 PMCID: PMC9515039 DOI: 10.1007/s00380-022-02093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/27/2022] [Indexed: 12/03/2022]
Abstract
Purpose For patients with aortic dissection (AD) and intramural hematoma (IMH), the optimal cardiac phase to detect intimal tears (IT) and ulcer-like projections (ULP) on retrospective electrocardiogram (ECG)-gated computed tomography angiography (CTA) remains unclear. The purpose of this study was to compare the accuracy of retrospective ECG-gated CTA for detecting IT in AD and ULP in IMH between each cardiac phase. Materials and methods A total of 75 consecutive patients with AD and IMH of the thoracic aorta were enrolled in this single-center retrospective study. The diagnostic performance to detect IT and ULP in the thoracic aortic regions (including the ascending aorta, aortic arch, and proximal and distal descending aorta) was compared in each cardiac phase on retrospective ECG-gated CTA. Results In the systolic phase (20%), the accuracy, sensitivity, and specificity to detect IT in AD was 64% (95% confidence interval [CI] 56–72%), 69% (95%CI 60–78%), and 25% (95%CI 3.3–45%), respectively. In the diastolic phase (70%), the accuracy, sensitivity, and specificity to detect IT in AD was 52% (95%CI 43–60%), 52% (95%CI 42–61%), and 50% (95%CI 25–75%), respectively. The accuracy to detect IT in AD on ECG-gated CTA was significantly higher in the systolic phase than that in the diastolic phase (P = 0.025). However, there were no differences in the accuracy (83%; 95%CI 78–89%), sensitivity (71%; 95%CI 62–80%), or specificity (100%; 95%CI 100%) to detect ULP in IMH between the cardiac cycle phases. Conclusion Although it is currently recommended for routine diagnosis of AD and IMH, single-diastolic-phase ECG-gated CTA has risk to miss some IT in AD that are detectable in the systolic phase on full-phase ECG-gated CTA. This information is critical for determining the optimal treatment strategy for AD.
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Huang F, Wu H, Lai QQ, Ke XT. Application value of preoperative dual-source computed tomography in assessing the rupture site of thoracic aortic dissection. J Cardiothorac Surg 2021; 16:346. [PMID: 34872588 PMCID: PMC8647340 DOI: 10.1186/s13019-021-01729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 11/22/2021] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the application value of dual-source computed tomography (DSCT) in preoperative assessment the rupture site of an thoracic aortic dissection (TAD). Methods A retrospective analysis of preoperative DSCT, multislice computed tomography (MSCT), and transthoracic echocardiography (TTE) results of 150 patients with suspected TAD in our hospital was conducted, and the intraoperative findings or interventional treatment results were used as the diagnostic gold standard. Results Of all 150 suspected TAD patients, 123 patients were confirmed to have TAD. The rupture site of TAD was in the ascending aorta in 46 patients, in the aortic arch in 13 patients, and in the descending aorta in 64 patients. The sensitivity of DSCT, MSCT, and TTE for locating the rupture site of the TAD was 100%, 93.5%, and 89.5%, respectively, and the specificity was 100%, 88.9%, and 81.5%. The differences were statistically significant. The distance between the actual rupture site and the one diagnosed by DSCT, MSCT, and TTE was 1.9 ± 1.2 mm, 5.1 ± 2.7 mm, and 7.8 ± 3.5 mm, respectively; the latter two were significantly worse than DSCT. The size of the rupture site diagnosed by DSCT, MSCT, and TTE was 1.5 ± 0.8 cm, 1.7 ± 0.9 cm, and 1.9 ± 1.0 cm, respectively. The size of the rupture site diagnosed by DSCT was not significantly different from the actual size of 1.4 ± 0.7 cm, while those by MSCT and TTE were. Conclusion DSCT has high sensitivity and specificity in diagnosing the rupture site of TAD and can clearly locate the rupture site. It can be a preferred imaging method for TAD.
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Affiliation(s)
- Fang Huang
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China.
| | - Hong Wu
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Qing-Quan Lai
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
| | - Xiao-Ting Ke
- Department of Radiology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou, China
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Dreisbach JG, Rodrigues JC, Roditi G. Emergency CT misdiagnosis in acute aortic syndrome. Br J Radiol 2021; 94:20201294. [PMID: 34491770 DOI: 10.1259/bjr.20201294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This cross-sectional study assessed the accuracy of emergency CT reports at presentation in acute aortic syndrome (AAS). METHODS Retrospective identification of cases of AAS presenting within a large health board with three acute hospitals receiving adult patients between January 2013 and December 2016. CT studies and reports at presentation were reviewed for discrepancies related to diagnosis, complications and classification by two cardiovascular radiologists. The specialist interest of the original reporters, clinically suspected diagnosis at referral for CT and technical adequacy of the scans were also assessed. False-positive diagnoses were identified and evaluated separately. RESULTS Among 88 consecutive confirmed cases of AAS at least one discrepancy was identified in 31% (n = 27), including failure to identify or misinterpretation of the AAS itself in 15% (n = 13), haemorrhage in 13% (n = 11), branch involvement in 9% (n = 8), and misclassification in 3% (n = 3). All discrepancies occurred among the 80% (n = 70) of cases reported by radiologists without specialist cardiovascular interest. 26% (n = 23/88) of AAS cases were not clinically suspected at referral for CT and although this was associated with suboptimal protocols, only 51% of CT scans among suspected cases were technically adequate. Seven false-positive diagnoses were identified, three of which related to motion artefact. CONCLUSION Significant discrepancies are common in the emergency CT assessment of positive cases AAS and this study highlights important pitfalls in CT technique and interpretation. The absence of discrepancies among radiologists with specialist cardiovascular interest suggests both suspected and confirmed cases warrant urgent specialist review. ADVANCES IN KNOWLEDGE CT angiography is central to the diagnosis of AAS; however, significant radiology discrepancies are common among non-specialists. This study highlights important pitfalls in both CT technique as well as interpretation and supports routine specialist cardiovascular imaging input in the emergency assessment of AAS.
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Affiliation(s)
- John G Dreisbach
- Department of Radiology, Golden Jubilee National Hospital, Clydebank, United Kingdom.,Department of Radiology, Glasgow Royal Infirmary, Glasgow, United Kingdom
| | - Jonathan Cl Rodrigues
- Department of Radiology, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, United Kingdom
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Kumar M, Sharma T, Jain M, Raj P, Singh D, Talha M, Kumar A, Kumar L. Computed Tomographic Evaluation of Mediastinal Masses - An Experience at a Tertiary Care Centre in Bareilly, India. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES 2021; 10:3017-3023. [DOI: 10.14260/jemds/2021/616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND Mediastinal lesions are one of the most common lesions of the chest in children and adults. Multidetector computed tomography (MDCT) is the most common investigation done in patients with suspected abnormalities on X-ray. Crosssectional imaging visualises complex anatomy, helps in predicting the tissue of origin, characterises lesions and depicts the extent of involvement of adjacent structures. Complications of mediastinal lesions and emergent conditions, for example, sealed pneumo-mediastinum, tracheoesophageal / pulmonary fistula, a peri-lesional abscess can be well assessed on CECT. The possibility of the lesion as benign or malignant and can be well predicted. Vascular lesions like aneurysms, dissections, and embolism can be evaluated and stable lesions requiring to follow up and unstable lesions requiring emergent treatment are differentiated using MDCT. The objectives of the study were to characterize and identify features pathognomic of specific mediastinal masses on computed tomography and find out diagnostic accuracy of MDCT in mediastinal masses and compare them with pathological results wherever possible. METHODS A prospective study was done in the Department of Radiodiagnosis, Rohilkhand Medical College and hospital, Bareilly for a span of 1 year from November 2018 to October 2019. Our study included 51 patients. Mediastinal lesions were assessed based on size, compartmental localisation, and attenuation and enhancement patterns. RESULTS In our study with 51 patients, 16 lesions were non-neoplastic and 35 were neoplastic lesions. Anterior mediastinal lesions constituted maximum lesions followed by middle and posterior mediastinal lesions. Lymph nodal masses were the commonest lesions out of which 4 cases were tubercular in origin, 4 were lymphomatous and 4 were metastatic. Neurogenic tumours were most common in the posterior mediastinum consisting of 6 cases. 2 vascular lesions were seen, 1 of aortic aneurysm and 1 aortic dissection. The diagnostic accuracy of MDCT was 93 % compared to histopathological results. Computed tomography (CT) plays a major role in evaluating mediastinal masses by virtue of its excellent multiplanar reconstruction capabilities and demonstration of exact anatomic relationships. However, in many situations, histopathological examination is needed to know the exact tissue of origin and for further management. CONCLUSIONS We conclude that CT has a major role in evaluating mediastinal masses regarding location, extent and tissue characterization. It can display certain features pathognomic for particular masses thus obviates the need for invasive procedures. KEY WORDS Mediastinal Lesions, MDCT, Imaging Modality, Histopathology
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Roccuzzo S, Mondello C, Salamone I, Gualniera P, Sapienza D, Scurria S, Asmundo A. Acute aortic syndrome and radiology liability in Italy: Case reports and medico-legal considerations. MEDICINE, SCIENCE, AND THE LAW 2021; 61:141-145. [PMID: 33591862 DOI: 10.1177/0025802420977977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The trend for medical malpractice claims has increased in recent years, both in the USA and in Europe. Although diagnostic radiology is not considered a high-risk field, malpractice claims in this area follow this general trend. The most common legal action taken against radiologists includes failure to diagnose, poor communication between physicians, failure to supervise technologists properly and improper procedures. Recently, the Italian Civil Supreme Court delivered a judgment (Cass. Civ., N.10158-18) regarding the liability of radiologists, stating that in radiological practice, a correct and timely execution of the diagnostic investigation is required. By contrast, the same judgment states that requesting further clinical consultations and/or the execution of in-depth diagnostic examinations are not within their duties. Considering this judgment, we report two cases of radiologist malpractice and related responsibility for negligent conduct regarding the diagnosis of thoracic aortic dissection and the prevention and management of acute aortic syndrome.
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Affiliation(s)
- Salvatore Roccuzzo
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Cristina Mondello
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Ignazio Salamone
- Departmental Section of Radiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Patrizia Gualniera
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Daniela Sapienza
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Serena Scurria
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
| | - Alessio Asmundo
- Departmental Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Italy
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Higashigaito K, Hinzpeter R, Baumueller S, Benz D, Manka R, Keller DI, Alkadhi H, Morsbach F. Chest pain CT in the emergency department: Watch out for the myocardium. Eur J Radiol Open 2018; 5:202-208. [PMID: 30456219 PMCID: PMC6232643 DOI: 10.1016/j.ejro.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/21/2018] [Indexed: 12/31/2022] Open
Abstract
Hypodense myocardium (HM) can be observed often in chest pain CT examinations of patients presenting to the emergency department with chest pain. There is benefit when the myocardium is also analyzed for the presence of HM, even when the heart and coronary arteries were not specifically asked-for. Sensitivity, specificity, PPV and NPV for the detection of acute myocardial infarction by assessing HM was 52%, 100%, 100% and 95% respectively. Assessment of hypodense myocardium may increase the diagnostic confidence in ambiguous coronary findings in chest pain CT.
Rationale and Objectives To evaluate the frequency and relevance of hypodense myocardium (HM) encountered in patients undergoing chest-pain CT in the emergency department (ED). Material and Methods In this IRB-approved retrospective study, ECG-gated chest-pain CT examinations of 300 consecutive patients (mean age 60 ± 17 years) presenting with acute chest-pain to our ED were evaluated. Once ST-segment elevation infarction was excluded, chest-pain CT including the coronary arteries (rule-out acute coronary syndrome (ACS), pulmonary embolism (PE) and acute aortic syndrome (AAS): chest-pain CTcoronary, n = 121) or not including the coronary arteries was performed (rule-out PE and AAS: chest-pain CTw/o coronary, n = 179). Each myocardial segment was assessed for the presence of HM; attenuation was measured and compared to normal myocardium. Results HM was identified in 27/300 patients (9%): 12/179 in chest-pain CTw/o coronary (7%) and 15/121 in chest-pain CTcoronary (12%). Mean attenuation of HM (40 ± 17 HU) was significantly lower than that of healthy myocardium (103 ± 18 HU, p < 0.001), with a mean difference of 61 ± 19 HU. In 15/27 patients (55.6%) with HM, the final diagnosis was acute MI, and in the remaining 12/27 patients (44.4%) previous MI was found in the patients’ history. Chest-pain CTw/o coronary identified HM in 10/15 patients (66.6%) with a final diagnosis of acute MI. Conclusion HM indicating acute MI are often encountered in chest pain CT in the ED, also in chest-pain CTw/o coronary when MI is not suspected. This indicates that the myocardium should always be analyzed for hypodense regions even when MI not suspected.
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Key Words
- AAC/AHA, American College of Cardiology / American Heart Association
- AAS, acute aortic syndrome
- ACS, acute coronary syndrome
- Acute chest pain
- BPM, beats per minute
- CAD, coronary artery disease
- CI, confidence interval
- CT, computed tomography
- CX, circumflex artery
- Cardiac
- Computed tomography
- ECG, electrocardiography
- ED, emergency department
- Emergency department
- HU, hounsfield unit
- ICC, intraclass correlation coefficients
- LAD, left anterior descending artery
- MH, hypodense myocardium
- MI, myocardial infarction
- NPV, negative predictive value
- NSTEMI, non-ST elevation myocardial infarction
- PE, pulmonary embolism
- PPV, positive predictive value
- RCA, right coronary artery
- ROI, region of interest
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Affiliation(s)
- Kai Higashigaito
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Ricarda Hinzpeter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Stephan Baumueller
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - David Benz
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Robert Manka
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland.,Department of Cardiology, University Hospital Zurich, University of Zurich, Switzerland.,Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Dagmar I Keller
- Institute for Emergency Medicine, University Hospital Zurich, University of Zurich, Switzerland
| | - Hatem Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
| | - Fabian Morsbach
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Switzerland
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Lu CY, Diao YK, Guo YQ, Zhang XH, Bai HL, Li ZL. Can multiphase dynamic CT angiography provide a better assessment of aortic dissection compared with the standard triphasic protocol? Acta Radiol 2018; 59:58-64. [PMID: 28440669 DOI: 10.1177/0284185117704236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Acute aortic dissection (AD) is a life-threatening medical emergency. It has been debated whether the multiphase dynamic computed tomography angiography (CTA) protocol is superior to the standard triphasic protocol for revealing the characteristics of AD. Purpose To examine two multiphase dynamic protocols, Dynamic four-dimensional (4D) CTA using the shuttle mode and Flash 4D CTA using the high-pitch mode for the assessment of AD and to compare them with the standard triphasic protocol. Material and Methods A total of 54 consecutive patients were randomly and equally assigned to three groups and scanned with a second-generation DSCT scanner. Groups A, B, and C were assessed with the Dynamic 4D CTA in the shuttle mode, the Flash 4D CTA in the high-pitch mode, and the standard triphasic acquisition protocol, respectively. Image quality of all patients was evaluated. The effective radiation dose (ED) was recorded. Results In 54 patients, CTA images could display the true and false lumens, the intimal flap, the entry tear, and branch vessel involvement in the AD. Compared with group C, additional diagnostic information was obtained in groups A and B, including the dynamic enhancement delay between the true and false lumens (A = 18, B = 18); the presence of membrane oscillation (A = 8, B = 14); dynamic ejection of the contrast material from the true lumen into the false lumen (A = 6, B = 7); and the dynamic obstruction of the left renal artery (B = 2). The ED in these three groups was significantly different ( P < 0.05). Conclusion Compared to the standard triphasic protocol, the multiphase dynamic CTA protocol is feasible and is able to reveal additional diagnostic information. Therefore, we recommend using the high-pitch, dual-source multiphase dynamic CTA to assess ADs.
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Affiliation(s)
- Chun-yan Lu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Yi-ke Diao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Ying-qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Xiao-hui Zhang
- Department of Healthcare Imaging & Therapy Division, Siemens Ltd. China, Nanhui, Shanghai, PR China
| | - Hong-li Bai
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Zhen-lin Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
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Occhipinti M, Heidinger BH, Franquet E, Eisenberg RL, Bankier AA. Imaging the posterior mediastinum: a multimodality approach. Diagn Interv Radiol 2016; 21:293-306. [PMID: 25993732 DOI: 10.5152/dir.2014.14467] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The posterior mediastinum contains several structures that can produce a wide variety of pathologic conditions. Descending thoracic aorta, esophagus, azygos and hemiazygos veins, thoracic duct, lymph nodes, adipose tissue, and nerves are all located in this anatomical region and can produce diverse abnormalities. Although chest radiography may detect many of these pathologic conditions, computed tomography and magnetic resonance are the imaging modalities of choice for further defining the relationship of posterior mediastinal lesions to neighboring structures and showing specific imaging features that narrow the differential diagnosis. This review emphasizes modality-related answers to morphologic questions, which provide precise diagnostic information.
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Affiliation(s)
- Mariaelena Occhipinti
- Department of Radiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
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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; 89:20150825. [PMID: 27033344 DOI: 10.1259/bjr.20150825] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Non-traumatic acute thoracic aortic syndromes (AAS) describe a spectrum of life-threatening aortic pathologies with significant implications on diagnosis, therapy and management. There is a common pathway for the various manifestations of AAS that eventually leads to a breakdown of the aortic intima and media. Improvements in biology and health policy and diffusion of technology into the community resulted in an associated decrease in mortality and morbidity related to aortic therapeutic interventions. Hybrid procedures, branched and fenestrated endografts, and percutaneous aortic valves have emerged as potent and viable alternatives to traditional surgeries. In this context, current state-of-the art multidetector CT (MDCT) is actually the gold standard in the emergency setting because of its intrinsic diagnostic value. Management of acute aortic disease has changed with the increasing realization that endovascular therapies may offer distinct advantages in these situations. This article provides a summary of AAS, focusing especially on the MDCT technique, typical and atypical findings and common pitfalls of AAS, as well as recent concepts regarding the subtypes of AAS, consisting of aortic dissection, intramural haematoma, penetrating atherosclerotic ulcer and unstable aortic aneurysm or contained aortic rupture. MDCT findings will be related to pathophysiology, timing and management options to achieve a definite and timely diagnostic and therapeutic definition. In the present article, we review the aetiology, pathophysiology, clinical presentation, outcomes and therapeutic approaches to acute aortic syndromes.
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Affiliation(s)
- Tullio Valente
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Giovanni Rossi
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Francesco Lassandro
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Gaetano Rea
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Maurizio Marino
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Maurizio Muto
- 1 Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, Naples, Italy
| | - Antonio Molino
- 2 Department of Pneumology, Section of Respiratory Diseases, University of Naples Federico II c/o Monaldi Hospital, Naples, Italy
| | - Mariano Scaglione
- 3 Department of Diagnostic Imaging, Presidio Ospedaliero "Pineta Grande", Caserta, Italy.,4 Department of Radiology, Darent Valley Hospital, Darfford, UK
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Vardhanabhuti V, Nicol E, Morgan-Hughes G, Roobottom CA, Roditi G, Hamilton MCK, Bull RK, Pugliese F, Williams MC, Stirrup J, Padley S, Taylor A, Davies LC, Bury R, Harden S. 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; 89:20150705. [PMID: 26916280 PMCID: PMC4985448 DOI: 10.1259/bjr.20150705] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Accurate and timely assessment of suspected acute aortic syndrome is crucial in this life-threatening condition. Imaging with CT plays a central role in the diagnosis to allow expedited management. Diagnosis can be made using locally available expertise with optimized scanning parameters, making full use of recent advances in CT technology. Each imaging centre must optimize their protocols to allow accurate diagnosis, to optimize radiation dose and in particular to reduce the risk of false-positive diagnosis that may simulate disease. This document outlines the principles for the acquisition of motion-free imaging of the aorta in this context.
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Affiliation(s)
- Varut Vardhanabhuti
- 1 Plymouth University Peninsula Schools of Medicine and Dentistry, John Bull Building, Plymouth, UK.,2 Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
| | - Edward Nicol
- 3 Radiology Department, Royal Brompton Hospital, London, UK
| | | | - Carl A Roobottom
- 1 Plymouth University Peninsula Schools of Medicine and Dentistry, John Bull Building, Plymouth, UK.,5 Department of Radiology, Derriford Hospital, Plymouth, UK
| | - Giles Roditi
- 6 Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Russell K Bull
- 8 Department of Radiology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Franchesca Pugliese
- 9 Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine & Barts Health NHS Trust, London, UK
| | - Michelle C Williams
- 10 University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James Stirrup
- 3 Radiology Department, Royal Brompton Hospital, London, UK
| | - Simon Padley
- 3 Radiology Department, Royal Brompton Hospital, London, UK
| | - Andrew Taylor
- 11 Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, UK
| | - L Ceri Davies
- 9 Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit, Barts and The London School of Medicine & Barts Health NHS Trust, London, UK
| | - Roger Bury
- 12 Radiology Department, Blackpool Teaching Hospitals, Blackpool, UK
| | - Stephen Harden
- 13 Department of Cardiothoracic Radiology, University Hospital Southampton NHS Trust, Southampton, UK
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12
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2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Radiol 2016; 13:e1-e29. [PMID: 26810814 DOI: 10.1016/j.jacr.2015.07.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 01/02/2023]
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13
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Rybicki FJ, Udelson JE, Peacock WF, Goldhaber SZ, Isselbacher EM, Kazerooni E, Kontos MC, Litt H, Woodard PK. 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain: A Joint Document of the American College of Radiology Appropriateness Criteria Committee and the American College of Cardiology Appropriate Use Criteria Task Force. J Am Coll Cardiol 2016; 67:853-79. [PMID: 26809772 DOI: 10.1016/j.jacc.2015.09.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Montgomery JP, Kolbeck KJ, Kaufman JA. Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms. Semin Intervent Radiol 2015; 32:249-58. [PMID: 26327743 DOI: 10.1055/s-0035-1556879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature.
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Affiliation(s)
- Jennifer P Montgomery
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - Kenneth J Kolbeck
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
| | - John A Kaufman
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon
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15
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Diagnosis and Management of Acute Aortic Syndromes: Dissection, Intramural Hematoma, and Penetrating Aortic Ulcer. Curr Cardiol Rep 2014; 16:536. [DOI: 10.1007/s11886-014-0536-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Santise G, Sciacca S, Ruperto C, Gentile G, Panarello G, Follis F. An unexpected finding complicating pericardial effusion and tamponade. J Cardiothorac Vasc Anesth 2014; 28:1174-6. [PMID: 25107729 DOI: 10.1053/j.jvca.2014.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Giovanna Panarello
- Anesthesiology Department, Mediterranean Institute for Transplantations and Highly Specialized Therapies, ISMETT, Palermo, Italy
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17
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Abbas A, Brown IW, Peebles CR, Harden SP, Shambrook JS. The role of multidetector-row CT in the diagnosis, classification and management of acute aortic syndrome. Br J Radiol 2014; 87:20140354. [PMID: 25083552 DOI: 10.1259/bjr.20140354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The term "acute aortic syndrome" (AAS) encompasses several non-traumatic life-threatening pathologies of the thoracic aorta presenting in patients with a similar clinical profile. These include aortic dissection, intramural haematoma and penetrating atherosclerotic ulcers. These different pathological entities can be indistinguishable on clinical grounds alone and may be confused with other causes of chest pain, including myocardial infarction. Multidetector-row CT (MDCT) is the current modality of choice for imaging AAS with a sensitivity and specificity approaching 100%. Early diagnosis and accurate radiological classification is associated with improved clinical outcomes in AAS. We review the characteristic radiological features of the different pathologies that encompass AAS and highlight the vital role of MDCT in determining the management of these life-threatening conditions.
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Affiliation(s)
- A Abbas
- Department of Cardiothoracic Radiology, University Hospital Southampton, Southampton, UK
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18
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Hallinan JTPD, Anil G. Multi-detector computed tomography in the diagnosis and management of acute aortic syndromes. World J Radiol 2014; 6:355-365. [PMID: 24976936 PMCID: PMC4072820 DOI: 10.4329/wjr.v6.i6.355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/26/2014] [Accepted: 04/19/2014] [Indexed: 02/06/2023] Open
Abstract
Acute aortic syndrome (AAS) is a spectrum of conditions, which may ultimately progress to potentially life-threatening aortic rupture. This syndrome encompasses aortic dissection (AD), intramural haematoma, penetrating atherosclerotic ulcer and unstable thoracic aortic aneurysms. Multi-detector CT (MDCT) is crucial for the diagnosis of AAS, especially in the emergency setting due to its speed, accuracy and ready availability. This review attends to the value of appropriate imaging protocols in obtaining good quality images that can permit a confident diagnosis of AAS. AD is the most commonly encountered AAS and also the one with maximum potential to cause catastrophic outcome if not diagnosed and managed promptly. Hence, this review briefly addresses certain relevant clinical perspectives on this condition. Differentiating the false from the true lumen in AD is often essential; a spectrum of CT findings, e.g., “beak sign”, aortic “cobwebs” that allows such differentiation have been described with explicit illustrations. The value of non enhanced CT scans, especially useful in the diagnosis of an intramural hematoma has also been illustrated. Overlap in the clinical and imaging features of the various conditions presenting as AAS is not unusual. However, on most instances MDCT enables the right diagnosis. On select occasions MRI or trans-esophageal echocardiography may be required as a problem solving tool.
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19
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Cariati M, Rossi UG. Letter reply re: "endovascular treatment of a symptomatic thoracoabdominal aortic aneurysm by chimney and periscope techniques for total visceral and renal artery revascularization". Cardiovasc Intervent Radiol 2014; 37:1392. [PMID: 24722892 DOI: 10.1007/s00270-014-0879-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 02/07/2014] [Indexed: 11/25/2022]
Affiliation(s)
- Maurizio Cariati
- Division of Radiology and Interventional Radiology, Department of Diagnostic Sciences, San Carlo Borromeo Hospital, Via Pio II, 3, 20153, Milan, Italy,
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20
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Re: Acute aortic syndrome: CT findings. A reply. Clin Radiol 2014; 69:e61. [DOI: 10.1016/j.crad.2013.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Indexed: 11/22/2022]
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21
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Bozzani A, Palmieri P, Arici V, Lovotti M, Ragni F. Re: Acute aortic syndrome: CT findings. Clin Radiol 2014; 69:e60. [DOI: 10.1016/j.crad.2013.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Indexed: 10/26/2022]
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22
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Reply: Acute aortic syndrome – A pictorial review of CT findings. Clin Radiol 2013; 68:e640. [DOI: 10.1016/j.crad.2013.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 11/22/2022]
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23
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Das I, Hoey ETD, Ganeshan A. Re: Acute aortic syndrome: CT findings. Clin Radiol 2013; 68:e639. [PMID: 23932673 DOI: 10.1016/j.crad.2013.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 06/21/2013] [Indexed: 11/26/2022]
Affiliation(s)
- I Das
- Heart of England NHS Foundation Trust, Heartlands Hospital, Birmingham, West Midlands, UK
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