The Common Vein Copyright 2007

Indications

Congenital – aortic coarctation, marfan syndrome

Trauma – pseudoaneurysm, transection

Acute aortic syndromes – aortic dissection, intramural hematoma, penetrating ulcer

Aneurysms – surveillance, pre-operative planning, followup after repair, rupture, mycotic

Atherosclerosis – aortic stenosis

Aortitis – Takayasu’s

Advantages

Ultrasound

–         Fast

–         available

–         inexpensive

–         non-ionizing radiation

CT

– fast, can image acutely ill patients

– available

MRI

–         non-ionizing radiation

Catheter Angiography

–         interventions: angioplasty, stenting

Disadvantages

Ultrasound

–         operator dependent

–         limited indications

CT

–         ionizing radiation

–         iodinated contrast material

MRI

–         cannot scan unstable patients

Catheter Angiography

–         invasive

–         ionizing radiation

–         iodinated contrast material

Method

Patient preparation none

Equipment

Ultrasound

CT

MRI

Catheter angiography

Technique

CTA

Non-contrast followed by contrast injection bolus timing

Gated if evaluating aortic root, ascending aortic aneurysm or cardiac evaluation

MRI/MRA

Thoracic aorta

Torso phased array coil, gadolinium 0.1 to 0.2 mmol/kg (20 – 30 mL)

Double inversion recovery fast spin echo

Cine gradient echo

Test bolus

Post-contrast 3D MRA, 2 to 3 mL/s, arterial and venous phases

Abdominal aorta

Torso phased array coil, gadolinium 0.1 to 0.2 mmol/kg (20 – 30 mL)

T1 gradient echo

Test bolus

Post contrast 3D MRA, 2 to 3 mL/s, arterial and venous phases

Results

Acute aortic dissection by MDCT¹

Sensitivity         99%

Specificity         100%

PPV                 100%

NPV                99.7%

Accuracy          99.5%

Thoracic aortic dissections by MRI²

Sensitivity         98.3%

Specificity         97.8%

Traumatic aortic rupture

Sensitivity         100%

Specificity         81.%

Intramural Hematoma, diagnostic accuracy by CT

Sensitivity         82%

Specificity         100%

Accuracy          84%

References

1. Hayter RG, Rhea JT, Small A, Tafazoli  FS, Novelline RA. Suspected Aortic Dissection and Other Aortic Disorders: Multi-Detector Row CT in 373 Cases in the Emergency Setting. Radiology 2006; 238:841-852.
2. Nienaber CA, von Kodolitsch Y, Nicols V, Siglow V, Piepho A, Brockhoff C, Koschyk DH, Spielmann RP. The Diagnosis of Thoracic Aortic Dissection by Noninvasive Imaging Procedures. NEJM 1993; 328:1-9.
3. Gavant ML, Menke PG, Fabian T, Flick PA, Graney MJ, Gold RE. Blunt Traumatic Aortic Rupture: Detection with Helical CT of the Chest. Radiology 1995; 197: 125-133.
4. Yoshida S, Akiba H, Tamakawa M, Yama N, Hareyama M, Morishita K, Abe T. Thoracic Involvement of Type A Aortic Dissection and Intramural Hematoma: Diagnostic Accuracy – comparison of Emergency Helical CT and Surgical Findings. Radiology 2003; 2

Translumbar Aortography

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Translumbar Aortography