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Review
. 2023 Feb 9;13(4):650.
doi: 10.3390/diagnostics13040650.

The Role of Multimodality Imaging Approach in Acute Aortic Syndromes: Diagnosis, Complications, and Clinical Management

Francesco Perone  1 , Marco Guglielmo  2 , Michele Coceani  3 , Lucia La Mura  4 , Ilaria Dentamaro  5 , Jolanda Sabatino  6 , Alessia Gimelli  7
Affiliations
Review

The Role of Multimodality Imaging Approach in Acute Aortic Syndromes: Diagnosis, Complications, and Clinical Management

Francesco Perone et al. Diagnostics (Basel). .

Abstract

Acute aortic syndromes are life-threatening conditions with high morbidity and mortality. The principal pathological feature is acute wall damage with possible evolution towards aortic rupture. Accurate and timely diagnosis is mandatory to avoid catastrophic consequences. Indeed, misdiagnosis with other conditions mimicking acute aortic syndromes is associated with premature death. In this view, cardiovascular imaging is necessary for the correct diagnosis and management. Echocardiography, computed tomography, magnetic resonance imaging, and aortography allow for diagnosis, guarantee immediate treatment, and detect associated complications. Multimodality imaging is essential in the diagnostic work-up to confirm or rule out acute aortic syndromes. The aim of this review is to highlight the contemporary evidence on the role of single cardiovascular imaging techniques and multimodality imaging in the diagnosis and management of acute aortic syndromes.

Keywords: acute aortic syndromes; aortography; computed tomography; echocardiography; magnetic resonance imaging; multimodality imaging.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
Multimodality imaging assessment of aortic dissection: (A) Two-dimensional transthoracic echocardiography showing a linear echo of an intimal flap (arrow) in a dilated aortic root above aortic valve level; (B) Two-dimensional transesophageal echocardiography in patients with aortic dissection involving the entire aorta; the false lumen (*) is typically larger and often compresses the true lumen, potentially affecting distal aortic flow; (C) CT image with evidence of the intimal tear (arrow) at the level of the aortic arch; (D) MRI with SSFP imaging in the oblique sagittal plane showing an intimal flap (arrow) from the aortic arch to abdominal aorta; (E) Aortic angiography performed in a patient with suspected inferior ST-segment elevation myocardial infarction revealing a type A aortic dissection (one may note that the pigtail catheter is located in the false lumen (*) of the dissection). CT, computed tomography; MRI, magnetic resonance imaging; SSFP, steady-state free precession.
Figure 2
Figure 2
Transesophageal echocardiography assessment in two different patients with acute aortic syndrome: (A) intramural hematoma and (B) penetrating aortic ulcer.
Figure 3
Figure 3
Intramural hematoma on CT using (A) non-contrast CT and (B) CT angiography: crescentic, high-attenuating regions of eccentrically thickened aortic wall on non-contrast CT (arrow). A diffuse pericardial effusion (*) was also visible in both scans. (C) Penetrating ulcer on CT: CT angiography image showing a penetrating ulcer of the descending aorta as a contrast-filled, out-pouching into the thickened aortic wall (arrow). CT, computed tomography.
Figure 4
Figure 4
Magnetic resonance imaging assessment of intramural hematoma (arrows). (A) Spin-Echo sequence. The eccentric thickening of the aortic wall has a high T1 signal, eliminating the possibility that it is an acute stage. (B) Late gadolinium- enhancement sequence. Aortic eccentric wall thickening with no mural enhancement, suggestive of intramural hematoma.
See this image and copyright information in PMC

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