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. 1990;17(4):271–278.

Optimal Diagnostic Imaging of Aortic Dissection

Christopher RH Wilbers 1,2, Clark L Carrol 1,2, Mark A Hnilica 1,2
PMCID: PMC324936  PMID: 15227519

Abstract

Without prompt diagnosis and treatment, aortic dissection is rapidly fatal. While standard chest radiography may give clues to the diagnosis of aortic dissection, suspected dissection can be confirmed by only 4 imaging techniques: aortography, echocardiography, computed tomography, and magnetic resonance imaging. The following review discusses each of these methods. It also explains why aortography, the previous diagnostic benchmark, has been replaced by newer techniques and why magnetic resonance imaging has become the diagnostic method of choice for imaging aortic dissection. (Texas Heart Institute Journal 1990;17:271-8)

Keywords: Aortic aneurysm/aneurysm, dissecting

Keywords: aortography

Keywords: diagnostic imaging

Keywords: diagnosis, cardiovascular

Keywords: echocardiography

Keywords: magnetic resonance imaging

Keywords: nuclear magnetic resonance

Keywords: thorax/radiography

Keywords: tomography, x-ray computed

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Akins E. W., Hill J. A., Carmichael M. J. MR imaging of blood pool signal variation with cardiac phase in aortic dissection. J Comput Assist Tomogr. 1987 May-Jun;11(3):543–545. doi: 10.1097/00004728-198705000-00037. [DOI] [PubMed] [Google Scholar]
  2. Amparo E. G., Higgins C. B., Hoddick W., Hricak H., Kerlan R. K., Ring E. J., Kaufman L., Hedgecock M. W. Magnetic resonance imaging of aortic disease: preliminary results. AJR Am J Roentgenol. 1984 Dec;143(6):1203–1209. doi: 10.2214/ajr.143.6.1203. [DOI] [PubMed] [Google Scholar]
  3. Amparo E. G., Higgins C. B., Hricak H., Sollitto R. Aortic dissection: magnetic resonance imaging. Radiology. 1985 May;155(2):399–406. doi: 10.1148/radiology.155.2.3983390. [DOI] [PubMed] [Google Scholar]
  4. Barentsz J. O., Ruijs J. H., Heystraten F. M., Buskens F. Magnetic resonance imaging of the dissected thoracic aorta. Br J Radiol. 1987 May;60(713):499–502. doi: 10.1259/0007-1285-60-713-499. [DOI] [PubMed] [Google Scholar]
  5. Bogren H. G., Underwood S. R., Firmin D. N., Mohiaddin R. H., Klipstein R. H., Rees R. S., Longmore D. B. Magnetic resonance velocity mapping in aortic dissection. Br J Radiol. 1988 Jun;61(726):456–462. doi: 10.1259/0007-1285-61-726-456. [DOI] [PubMed] [Google Scholar]
  6. Demos T. C., Posniak H. V., Marsan R. E. CT of aortic dissection. Semin Roentgenol. 1989 Jan;24(1):22–37. doi: 10.1016/0037-198x(89)90051-5. [DOI] [PubMed] [Google Scholar]
  7. Dinsmore R. E., Liberthson R. R., Wismer G. L., Miller S. W., Liu P., Thompson R., McLoud T. C., Marshall J., Saini S., Stratemeier E. J. Magnetic resonance imaging of thoracic aortic aneurysms: comparison with other imaging methods. AJR Am J Roentgenol. 1986 Feb;146(2):309–314. doi: 10.2214/ajr.146.2.309. [DOI] [PubMed] [Google Scholar]
  8. Dinsmore R. E., Wedeen V. J., Miller S. W., Rosen B. R., Fifer M., Vlahakes G. J., Edelman R. R., Brady T. J. MRI of dissection of the aorta: recognition of the intimal tear and differential flow velocities. AJR Am J Roentgenol. 1986 Jun;146(6):1286–1288. doi: 10.2214/ajr.146.6.1286. [DOI] [PubMed] [Google Scholar]
  9. Erbel R., Engberding R., Daniel W., Roelandt J., Visser C., Rennollet H. Echocardiography in diagnosis of aortic dissection. Lancet. 1989 Mar 4;1(8636):457–461. doi: 10.1016/s0140-6736(89)91364-0. [DOI] [PubMed] [Google Scholar]
  10. Fruehwald F. X., Neuhold A., Fezoulidis J., Globits S., Mayr H., Wicke K., Glogar D. Cine-MR in dissection of the thoracic aorta. Eur J Radiol. 1989 Feb;9(1):37–41. [PubMed] [Google Scholar]
  11. Geisinger M. A., Risius B., O'Donnell J. A., Zelch M. G., Moodie D. S., Graor R. A., George C. R. Thoracic aortic dissections: magnetic resonance imaging. Radiology. 1985 May;155(2):407–412. doi: 10.1148/radiology.155.2.3983391. [DOI] [PubMed] [Google Scholar]
  12. Glazer H. S., Gutierrez F. R., Levitt R. G., Lee J. K., Murphy W. A. The thoracic aorta studied by MR imaging. Radiology. 1985 Oct;157(1):149–155. doi: 10.1148/radiology.157.1.2863853. [DOI] [PubMed] [Google Scholar]
  13. Goldman A. P., Kotler M. N., Scanlon M. H., Ostrum B. J., Parameswaran R., Parry W. R. Magnetic resonance imaging and two-dimensional echocardiography. Alternative approach to aortography in diagnosis of aortic dissecting aneurysm. Am J Med. 1986 Jun;80(6):1225–1229. doi: 10.1016/0002-9343(86)90693-5. [DOI] [PubMed] [Google Scholar]
  14. Goldman A. P., Kotler M. N., Scanlon M. H., Ostrum B., Parameswaran R., Parry W. R. The complementary role of magnetic resonance imaging, Doppler echocardiography, and computed tomography in the diagnosis of dissecting thoracic aneurysms. Am Heart J. 1986 May;111(5):970–981. doi: 10.1016/0002-8703(86)90648-4. [DOI] [PubMed] [Google Scholar]
  15. Hill J. A., Lambert C. R., Akins E. W., Carmichael M. J. Ascending aortic dissection: detection by MRI. Am Heart J. 1985 Oct;110(4):894–896. doi: 10.1016/0002-8703(85)90480-6. [DOI] [PubMed] [Google Scholar]
  16. Kasper W., Hofmann T., Meinertz T., Billmann P., Byrtus M., Lang K., Spillner G., Schlosser V., Just H. Diagnostik thorakaler Aortenaneurysmen und Dissektionen mit Hilfe der transösophagealen Echokardiographie. Z Kardiol. 1986 Oct;75(10):609–615. [PubMed] [Google Scholar]
  17. Kersting-Sommerhoff B. A., Higgins C. B., White R. D., Sommerhoff C. P., Lipton M. J. Aortic dissection: sensitivity and specificity of MR imaging. Radiology. 1988 Mar;166(3):651–655. doi: 10.1148/radiology.166.3.3340758. [DOI] [PubMed] [Google Scholar]
  18. Kittredge R. D., Gordon R. B. CT demonstration of dissecting hematoma originating in abdominal aorta. J Comput Assist Tomogr. 1987 Mar-Apr;11(2):279–281. doi: 10.1097/00004728-198703000-00017. [DOI] [PubMed] [Google Scholar]
  19. Lotan C. S., Cranney G. B., Doyle M., Pohost G. M. Fat-shift artifact simulating aortic dissection on MR images. AJR Am J Roentgenol. 1989 Feb;152(2):385–386. doi: 10.2214/ajr.152.2.385. [DOI] [PubMed] [Google Scholar]
  20. Mitchell L., Jenkins J. P., Brownlee W. C., Isherwood I. Aortic dissection: morphology and differential flow velocity patterns demonstrated by magnetic resonance imaging. Clin Radiol. 1988 Jul;39(4):458–461. doi: 10.1016/s0009-9260(88)80311-8. [DOI] [PubMed] [Google Scholar]
  21. Pernes J. M., Grenier P., Desbleds M. T., de Brux J. L. MR evaluation of chronic aortic dissection. J Comput Assist Tomogr. 1987 Nov-Dec;11(6):975–981. doi: 10.1097/00004728-198711000-00009. [DOI] [PubMed] [Google Scholar]
  22. Sasaki S., Yoshida H., Matsui Y., Sakuma M., Yasuda K., Tanade T. [The value of recent non-invasive medical imagings in diagnosis of dissecting aortic aneurysm; further investigation on transesophageal echocardiography and MRI]. Kyobu Geka. 1989 Apr;42(4):297–302. [PubMed] [Google Scholar]
  23. Shin M. S., Zorn G. L., Ho K. J. Computed tomography manifestation of a triple-barreled aortic dissection: the Mercedes-Benz mark sign. J Comput Tomogr. 1988 Apr;12(2):140–143. doi: 10.1016/0149-936x(88)90069-0. [DOI] [PubMed] [Google Scholar]
  24. Singh H., Fitzgerald E., Ruttley M. S. Computed tomography: the investigation of choice for aortic dissection? Br Heart J. 1986 Aug;56(2):171–175. doi: 10.1136/hrt.56.2.171. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. St Amour T. E., Gutierrez F. R., Levitt R. G., McKnight R. C. CT diagnosis of type A aortic dissections not demonstrated by aortography. J Comput Assist Tomogr. 1988 Nov-Dec;12(6):963–967. doi: 10.1097/00004728-198811000-00010. [DOI] [PubMed] [Google Scholar]
  26. Valk P. E., Hale J. D., Crooks L. E., Kaufman L., Higgins C. B. Magnetic resonance imaging of aortic aneurysms with 3-D image reconstruction. Australas Radiol. 1987 May;31(2):196–201. doi: 10.1111/j.1440-1673.1987.tb01809.x. [DOI] [PubMed] [Google Scholar]
  27. Yamada T., Tada S., Harada J. Aortic dissection without intimal rupture: diagnosis with MR imaging and CT. Radiology. 1988 Aug;168(2):347–352. doi: 10.1148/radiology.168.2.3393653. [DOI] [PubMed] [Google Scholar]
  28. Zeitler E., Kaiser W., Schuierer G., Wojtowycz M., Kunigk K., Oppelt A., Stetter E., von Wulfen H., Raithel D. Magnetic resonance imaging of aneurysms and thrombi. Cardiovasc Intervent Radiol. 1986;8(5-6):321–328. doi: 10.1007/BF02552369. [DOI] [PubMed] [Google Scholar]
  29. von Schulthess G. K., Augustiny N. Calculation of T2 values versus phase imaging for the distinction between flow and thrombus in MR imaging. Radiology. 1987 Aug;164(2):549–554. doi: 10.1148/radiology.164.2.3602400. [DOI] [PubMed] [Google Scholar]

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