Imaging

Imaging

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

 

 

Imaging

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
22776c01 aorta kidney renal artery stenosis occlusion bone spine v

Translumbar Aortography

22776c01 aorta kidney renal artery stenosis occlusion bone spine vertebra fx sclerosis of the endplates sign rugger jersey spine dx chronic renal failure translumbar aortography TLA angiography Courtesy Ashley Davidoff MD