Imaging diagnosis progress of chronic aortic dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XIAO Zhenghua , HU Jia ,  MENG Wei

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

MENG Wei, Email: meng_wei_1111@yahoo.com

Keywords：

Chronic aortic dissection; type B aortic dissection; type A aortic dissection; magnetic resonance imaging

DOI：

10.7507/1007-4848.201608063

Video：

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Acute aortic dissection is featured as sudden onset and high mortality. Regardless early optimal surgical intervention and strict medical therapy, incidence of late complications is still high. Thus, specific imaging techniques and precise measurement of biomarkers to predict complications are needed. In the present study, we reviewed related papers to compare traditional imaging techniques (computed tomography, echocardiography) and magnetic resonance imaging (MRI) in the diagnosis of chronic aortic dissection. In addition, we discussed how to further evaluate aortic dissection by MRI.

Citation： XIAO Zhenghua, HU Jia, MENG Wei. Imaging diagnosis progress of chronic aortic dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(7): 558-562. doi: 10.7507/1007-4848.201608063 Copy

1.	Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2): 149-159.
2.	Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection. Eur Heart J, 2001, 22(18): 1642-1681.
3.	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): 1661-1678.
4.	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): 2873-2926.
5.	蒙炜, 张尔永, 杨建, 等. 主动脉夹层的外科治疗. 中国胸心血管外科临床杂志, 2009, 16(1): 40-42.
6.	Braverman AC. Acute aortic dissection: clinician update. Circulation, 2010, 122(2): 184-188.
7.	Jonker FH, Trimarchi S, Rampoldi V, et al. Aortic expansion after acute type B aortic dissection. Ann Thorac Surg, 2012, 94(4): 1223-1229.
8.	Elefteriades JA, Lovoulos CJ, Coady MA, et al. Management of descending aortic dissection. Ann Thorac Surg, 1999, 67(6): 2002-2005.
9.	Kirsch M, Legras A, Bruzzi M, et al. Fate of the distal aorta after surgical repair of acute DeBakey type I aortic dissection: a review. Arch Cardiovasc Dis, 2011, 104(2): 125-130.
10.	Albrecht F, Eckstein F, Matt P. Is close radiographic and clinical control after repair of acute type A aortic dissection really necessary for improved long-term survival? Interact Cardiovasc Thorac Surg, 2010, 11(5): 620-625.
11.	Blount KJ, Hagspiel KD. Aortic diameter, true lumen, and false lumen growth rates in chronic type B aortic dissection. AJR Am J Roentgenol, 2009, 192(5): W222-W229.
12.	Reeps C, Pelisek J, Bundschuh R A, et al. Imaging of acute and chronic aortic dissection by 18F-FDG PET/CT. J Nucl Med, 2010, 51(5): 686-691.
13.	Sherrah AG, Vallely MP, Grieve SM, et al. Clinical utility of magnetic resonance imaging in the follow-up of chronic aortic type B dissection. Heart Lung Circ, 2014, 23(7): e157-e159.
14.	Moore AG, Eagle KA, Bruckman D, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: international registry of acute aortic dissection (IRAD). Am J Cardiol, 2002, 89: 1235-1238.
15.	Shiga T, Wajima Z, Apfel CC, et al. 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: 1350-1356.
16.	Di Cesare E, Giordano AV, Cerone G, et al. Comparative evaluation of TEE, conventional MRI and contrast-enhanced 3D breath-hold MRA in the post-operative follow-up of dissecting aneurysms. Int J Card Imaging, 2000, 16(3): 135-147.
17.	Masani ND, Banning AP, Jones RA, et al. Follow-up of chronic thoracic aortic dissection: comparison of transesophageal echocardiography and magnetic resonance imaging. Am Heart J, 1996, 131(6): 1156-1163.
18.	Deutsch HJ, Sechtem U, Meyer H, et al. Chronic aortic dissection: comparison of MR imaging and transesophageal echocardiography. Radiology, 1994, 192(3): 645-650.
19.	Evangelista A, Aguilar R, Cuellar H, et al. Usefulness of real-time three-dimensional transoesophageal echocardiography in the assessment of chronic aortic dissection. Eur J Echocardiogr, 2011, 12(4): 272-277.
20.	王照谦, 刘玉清, 张挽时, 等. 主动脉夹层的 MRI 与综合超声诊断对照研究. 中华放射学杂志, 1997, 31(8): 532-535.
21.	Cecconi M, La Canna G, Manfrin M, et al. Postoperative follow-up in type A aortic dissection: comparison of transesophageal lechocardiography and magnetic resonance imaging. Cardiovasc Imaging, 1997, 9: 119-122.
22.	Bhatla P, Nielsen JC. Cardiovascular magnetic resonance as an alternate method for serial evaluation of proximal aorta: comparison with echocardiography. Echocardiography, 2013, 30(6): 713-718.
23.	Evangelista A, Flachskampf FA, Erbel R, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr, 2010, 11(8): 645-658.
24.	Sharma UK, Gulati MS, Mukhopadhyay S. Aortic aneurysm and dissection: evaluation with spiral CT angiography. JNMA J Nepal Med Assoc, 2005, 44(157): 8-12.
25.	卢春燕, 杨志刚, 杨建, 等. 16 层螺旋 CT 对主动脉夹层的诊断价值. 中国胸心血管外科临床杂志, 2008, 15(4): 260-263.
26.	Xu J, Zhao H, Wang X, et al. Accuracy, image quality, and radiation dose of prospectively ECG-triggered high-pitch dual-source CT angiography in infants and children with complex coarctation of the aorta. Acad Radiol, 2014, 21(10):1248-1254.
27.	Koike Y, Ishida K, Hase S, et al. Dynamic volumetric CT angiography for the detection and classification of endoleaks: application of cine imaging using a 320-row CT scanner with 16-cm detectors. J Vasc Interv Radiol, 2014, 25(8): 1172-1180.
28.	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: executive summary. Circulation, 2010, 121(13): 1544-1579.
29.	Ganten MK, Weber TF, Tengg-Kobligk von H, et al. Motion characterization of aortic wall and intimal flap by ECG-gated CT in patients with chronic B-dissection. Eur J Radiol, 2009, 72(1): 146-153.
30.	Weber TF, Ganten MK, Boeckler D, et al. Assessment of thoracic aortic conformational changes by four-dimensional computed tomography angiography in patients with chronic aortic dissection type B. Eur Radiol, 2008, 19(1): 245-253.
31.	Maspes F, Gandini R, Pocek M, et al. Breath-hold gadolinium enhanced tree-dimensional MR angiography: personal experience in the thoracic-abdominal area. Radiol Med, 1999, 98(4): 275-282.
32.	Razavi M. Acute dissection of the aorta: options for diagnostic imaging. Cleve Clin J Med, 1995, 62(6): 360-365.
33.	Yamada E, Matsumura M, Kyo S, et al. Usefulness of a prototype intravascular ultrasound imaging in evaluation of aortic dissection and comparison with angiographic study, transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Am J Cardiol, 1995, 75:161-165.
34.	Grenier P, Pernes JM, Desbleds MT, et al. Magnetic resonance imaging of aneurysms and chronic dissections of the thoracic aorta. Ann Vasc Surg, 1987, 1(5): 534-41.
35.	Gaubert JY, Moulin G, Mesana T, et al. Type A dissection of the thoracic aorta: use of MR imaging for long-term follow-up. Radiology, 1995, 196: 363-369.
36.	Francois CJ, Markl M, Schiebler ML, et al. Four-dimensional, flow-sensitive magnetic resonance imaging of blood flow patterns in thoracic aortic dissections. J Thorac Cardiovasc Surg, 2013, 145(5):1359-1366.
37.	Do C, Barnes JL, Tan C, et al. Type of MRI contrast, tissue gadolinium, and fibrosis. Am J Physiol Renal Physiol, 2014, 307(7): F844-F855.
38.	Sueyoshi E, Sakamoto I, Hayashi K, et al. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation, 2004, 110(11 Suppl 1): II256-II261.
39.	Amano Y, Sekine T, Suzuki Y, et al. Time-resolved three-dimensional magnetic resonance velocity mapping of chronic thoracic aortic dissection: a preliminary investigation. Magn Reson Med Sci, 2011, 10(2): 93-99.
40.	Almeida AG, Nobre AL, Pereira RA, et al. Impact of aortic dimensions and pulse pressure on late aneurysm formation in operated type A aortic dissection. A magnetic resonance imaging study. Int J Cardiovasc Imaging, 2008, 24(6): 633-640.
41.	Garcia A, Ferreiros J, Santamaria M, et al. MR angiographic evaluation of complications in surgically treated type A aortic dissection. Radiographics, 2006, 26(4): 981-992.
42.	范占明, 张兆琪, 刘玉清, 等. 快速屏气 MRI 技术对主动脉夹层的诊断价值. 中华放射学杂志, 2003, 37(8): 737-741.
43.	Strotzer M, Aebert H, Lenhart M, et al. Morphology and hemodynamics in dissection of the descending aorta. Assessment with MR imaging. Acta Radiol, 2000, 41(6): 594-600.
44.	Muller-Eschner M, Rengier F, Partovi S, et al. Tridirectional phase-contrast magnetic resonance velocity mapping depicts severe hemodynamic alterations in a patient with aortic dissection type Stanford B. J Vasc Surg, 2011, 54(2): 559-562.
45.	Maj E, Cieszanowski A, Rowinski O, et al. Time-resolved contrast-enhanced MR angiography: Value of hemodynamic information in the assessment of vascular diseases. Pol J Radiol, 2010, 75(1): 52-60.
46.	Clough RE, Waltham M, Giese D, et al. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging. J Vasc Surg, 2012, 55(4): 914-23.
47.	Francois CJ, Markl M, Schiebler ML, et al. Four-dimensional, flow-sensitive magnetic resonance imaging of blood flow patterns in thoracic aortic dissections. J Thorac Cardiovasc Surg, 2013, 145(5): 1359-1366.
48.	Meierhofer C, Schneider EP, Lyko C, et al. Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study. Eur Heart J Cardiovasc Imaging, 2013, 14(8): 797-804.

1. Tsai TT, Trimarchi S, Nienaber CA. Acute aortic dissection: perspectives from the International Registry of Acute Aortic Dissection (IRAD). Eur J Vasc Endovasc Surg, 2009, 37(2): 149-159.
2. Erbel R, Alfonso F, Boileau C, et al. Diagnosis and management of aortic dissection. Eur Heart J, 2001, 22(18): 1642-1681.
3. 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): 1661-1678.
4. 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): 2873-2926.
5. 蒙炜, 张尔永, 杨建, 等. 主动脉夹层的外科治疗. 中国胸心血管外科临床杂志, 2009, 16(1): 40-42.
6. Braverman AC. Acute aortic dissection: clinician update. Circulation, 2010, 122(2): 184-188.
7. Jonker FH, Trimarchi S, Rampoldi V, et al. Aortic expansion after acute type B aortic dissection. Ann Thorac Surg, 2012, 94(4): 1223-1229.
8. Elefteriades JA, Lovoulos CJ, Coady MA, et al. Management of descending aortic dissection. Ann Thorac Surg, 1999, 67(6): 2002-2005.
9. Kirsch M, Legras A, Bruzzi M, et al. Fate of the distal aorta after surgical repair of acute DeBakey type I aortic dissection: a review. Arch Cardiovasc Dis, 2011, 104(2): 125-130.
10. Albrecht F, Eckstein F, Matt P. Is close radiographic and clinical control after repair of acute type A aortic dissection really necessary for improved long-term survival? Interact Cardiovasc Thorac Surg, 2010, 11(5): 620-625.
11. Blount KJ, Hagspiel KD. Aortic diameter, true lumen, and false lumen growth rates in chronic type B aortic dissection. AJR Am J Roentgenol, 2009, 192(5): W222-W229.
12. Reeps C, Pelisek J, Bundschuh R A, et al. Imaging of acute and chronic aortic dissection by 18F-FDG PET/CT. J Nucl Med, 2010, 51(5): 686-691.
13. Sherrah AG, Vallely MP, Grieve SM, et al. Clinical utility of magnetic resonance imaging in the follow-up of chronic aortic type B dissection. Heart Lung Circ, 2014, 23(7): e157-e159.
14. Moore AG, Eagle KA, Bruckman D, et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: international registry of acute aortic dissection (IRAD). Am J Cardiol, 2002, 89: 1235-1238.
15. Shiga T, Wajima Z, Apfel CC, et al. 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: 1350-1356.
16. Di Cesare E, Giordano AV, Cerone G, et al. Comparative evaluation of TEE, conventional MRI and contrast-enhanced 3D breath-hold MRA in the post-operative follow-up of dissecting aneurysms. Int J Card Imaging, 2000, 16(3): 135-147.
17. Masani ND, Banning AP, Jones RA, et al. Follow-up of chronic thoracic aortic dissection: comparison of transesophageal echocardiography and magnetic resonance imaging. Am Heart J, 1996, 131(6): 1156-1163.
18. Deutsch HJ, Sechtem U, Meyer H, et al. Chronic aortic dissection: comparison of MR imaging and transesophageal echocardiography. Radiology, 1994, 192(3): 645-650.
19. Evangelista A, Aguilar R, Cuellar H, et al. Usefulness of real-time three-dimensional transoesophageal echocardiography in the assessment of chronic aortic dissection. Eur J Echocardiogr, 2011, 12(4): 272-277.
20. 王照谦, 刘玉清, 张挽时, 等. 主动脉夹层的 MRI 与综合超声诊断对照研究. 中华放射学杂志, 1997, 31(8): 532-535.
21. Cecconi M, La Canna G, Manfrin M, et al. Postoperative follow-up in type A aortic dissection: comparison of transesophageal lechocardiography and magnetic resonance imaging. Cardiovasc Imaging, 1997, 9: 119-122.
22. Bhatla P, Nielsen JC. Cardiovascular magnetic resonance as an alternate method for serial evaluation of proximal aorta: comparison with echocardiography. Echocardiography, 2013, 30(6): 713-718.
23. Evangelista A, Flachskampf FA, Erbel R, et al. Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr, 2010, 11(8): 645-658.
24. Sharma UK, Gulati MS, Mukhopadhyay S. Aortic aneurysm and dissection: evaluation with spiral CT angiography. JNMA J Nepal Med Assoc, 2005, 44(157): 8-12.
25. 卢春燕, 杨志刚, 杨建, 等. 16 层螺旋 CT 对主动脉夹层的诊断价值. 中国胸心血管外科临床杂志, 2008, 15(4): 260-263.
26. Xu J, Zhao H, Wang X, et al. Accuracy, image quality, and radiation dose of prospectively ECG-triggered high-pitch dual-source CT angiography in infants and children with complex coarctation of the aorta. Acad Radiol, 2014, 21(10):1248-1254.
27. Koike Y, Ishida K, Hase S, et al. Dynamic volumetric CT angiography for the detection and classification of endoleaks: application of cine imaging using a 320-row CT scanner with 16-cm detectors. J Vasc Interv Radiol, 2014, 25(8): 1172-1180.
28. 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: executive summary. Circulation, 2010, 121(13): 1544-1579.
29. Ganten MK, Weber TF, Tengg-Kobligk von H, et al. Motion characterization of aortic wall and intimal flap by ECG-gated CT in patients with chronic B-dissection. Eur J Radiol, 2009, 72(1): 146-153.
30. Weber TF, Ganten MK, Boeckler D, et al. Assessment of thoracic aortic conformational changes by four-dimensional computed tomography angiography in patients with chronic aortic dissection type B. Eur Radiol, 2008, 19(1): 245-253.
31. Maspes F, Gandini R, Pocek M, et al. Breath-hold gadolinium enhanced tree-dimensional MR angiography: personal experience in the thoracic-abdominal area. Radiol Med, 1999, 98(4): 275-282.
32. Razavi M. Acute dissection of the aorta: options for diagnostic imaging. Cleve Clin J Med, 1995, 62(6): 360-365.
33. Yamada E, Matsumura M, Kyo S, et al. Usefulness of a prototype intravascular ultrasound imaging in evaluation of aortic dissection and comparison with angiographic study, transesophageal echocardiography, computed tomography, and magnetic resonance imaging. Am J Cardiol, 1995, 75:161-165.
34. Grenier P, Pernes JM, Desbleds MT, et al. Magnetic resonance imaging of aneurysms and chronic dissections of the thoracic aorta. Ann Vasc Surg, 1987, 1(5): 534-41.
35. Gaubert JY, Moulin G, Mesana T, et al. Type A dissection of the thoracic aorta: use of MR imaging for long-term follow-up. Radiology, 1995, 196: 363-369.
36. Francois CJ, Markl M, Schiebler ML, et al. Four-dimensional, flow-sensitive magnetic resonance imaging of blood flow patterns in thoracic aortic dissections. J Thorac Cardiovasc Surg, 2013, 145(5):1359-1366.
37. Do C, Barnes JL, Tan C, et al. Type of MRI contrast, tissue gadolinium, and fibrosis. Am J Physiol Renal Physiol, 2014, 307(7): F844-F855.
38. Sueyoshi E, Sakamoto I, Hayashi K, et al. Growth rate of aortic diameter in patients with type B aortic dissection during the chronic phase. Circulation, 2004, 110(11 Suppl 1): II256-II261.
39. Amano Y, Sekine T, Suzuki Y, et al. Time-resolved three-dimensional magnetic resonance velocity mapping of chronic thoracic aortic dissection: a preliminary investigation. Magn Reson Med Sci, 2011, 10(2): 93-99.
40. Almeida AG, Nobre AL, Pereira RA, et al. Impact of aortic dimensions and pulse pressure on late aneurysm formation in operated type A aortic dissection. A magnetic resonance imaging study. Int J Cardiovasc Imaging, 2008, 24(6): 633-640.
41. Garcia A, Ferreiros J, Santamaria M, et al. MR angiographic evaluation of complications in surgically treated type A aortic dissection. Radiographics, 2006, 26(4): 981-992.
42. 范占明, 张兆琪, 刘玉清, 等. 快速屏气 MRI 技术对主动脉夹层的诊断价值. 中华放射学杂志, 2003, 37(8): 737-741.
43. Strotzer M, Aebert H, Lenhart M, et al. Morphology and hemodynamics in dissection of the descending aorta. Assessment with MR imaging. Acta Radiol, 2000, 41(6): 594-600.
44. Muller-Eschner M, Rengier F, Partovi S, et al. Tridirectional phase-contrast magnetic resonance velocity mapping depicts severe hemodynamic alterations in a patient with aortic dissection type Stanford B. J Vasc Surg, 2011, 54(2): 559-562.
45. Maj E, Cieszanowski A, Rowinski O, et al. Time-resolved contrast-enhanced MR angiography: Value of hemodynamic information in the assessment of vascular diseases. Pol J Radiol, 2010, 75(1): 52-60.
46. Clough RE, Waltham M, Giese D, et al. A new imaging method for assessment of aortic dissection using four-dimensional phase contrast magnetic resonance imaging. J Vasc Surg, 2012, 55(4): 914-23.
47. Francois CJ, Markl M, Schiebler ML, et al. Four-dimensional, flow-sensitive magnetic resonance imaging of blood flow patterns in thoracic aortic dissections. J Thorac Cardiovasc Surg, 2013, 145(5): 1359-1366.
48. Meierhofer C, Schneider EP, Lyko C, et al. Wall shear stress and flow patterns in the ascending aorta in patients with bicuspid aortic valves differ significantly from tricuspid aortic valves: a prospective study. Eur Heart J Cardiovasc Imaging, 2013, 14(8): 797-804.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Imaging diagnosis progress of chronic aortic dissection

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