Predictive imaging for thoracic aortic dissection and rupture: moving beyond diameters

Bouke P. Adriaans*, Joachim E. Wildberger, Jos J. M. Westenberg, Hildo J. Lamb, Simon Schalla

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

29 Citations (Web of Science)

Abstract

Acute aortic syndromes comprise a group of potentially fatal conditions that result from weakening of the aortic vessel wall. Pre-emptive surgical intervention is currently reserved for patients with severe aortic dilatation, although abundant evidence describes the occurrence of dissection and rupture in aortas with diameters below surgical thresholds. Modern imaging techniques (such as hybrid PET-CT and 4D flow MRI) afford the non-invasive assessment of anatomic, hemodynamic, and molecular features of the aorta, and may provide for a more accurate selection of patients who will benefit from preventative surgical intervention. In the current review, we summarize evidence and considerations regarding predictive aortic imaging and highlight evolving imaging modalities that have shown promise to improve risk assessment for the occurrence of dissection and rupture.

Key Points

Guidelines for the preventative management of aortic disease depend on maximal vessel diameters, while these have shown to be poor predictors for the occurrence of catastrophic acute aortic events.

Evolving imaging modalities (such as 4D flow MRI and hybrid PET-CT) afford a more comprehensive insight into anatomic, hemodynamic, and molecular features of the aorta and have shown promise to detect vessel wall instability at an early stage.

Original languageEnglish
Pages (from-to)6396-6404
Number of pages9
JournalEuropean Radiology
Volume29
Issue number12
DOIs
Publication statusPublished - Dec 2019

Keywords

  • Aorta
  • Aortic dissection
  • Aortic aneurysm
  • Type A dissection
  • Aortic rupture
  • WALL SHEAR-STRESS
  • COMPUTED-TOMOGRAPHY
  • ANEURYSM GROWTH
  • ASCENDING AORTA
  • A DISSECTION
  • RISK-FACTOR
  • VALVE
  • INFLAMMATION
  • PET/CT
  • ELONGATION

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