One multidetector CT study enrolling 57 patients has reported sensitivities and specificities of 100% [22]. CT findings may also be used to predict patient outcome. For example, in one retrospective study of 83 patients with type B dissections, the morphologic features of a dissection were associated with an increase in late adverse events [27]. CTA with IV contrast also enables detection of focal intimal disruptions or also ulcer-like projections as prognostic indicators in IMH. In one study of 107 patients, aorta-related death or need for invasive surgery was increased when focal intimal disruptions or ulcer-like projections were present (hazard ratio, 24.43) [29]. CTA with IV contrast can be used to diagnose penetrating PAU, but contrast does not enable additional prognostic imaging findings. PAU prognosis has been associated with the presence or absence of aortic rupture, but in one study, aortic diameter, ulcer size, or the presence of IMH did not affect prognosis [30]. Compared with CTA chest, TRO CT protocols can be used to assess for additional, potentially fatal possibilities such as pulmonary embolism and acute coronary syndrome [31,32]. It has been reported that TRO CT can safely eliminate further diagnostic testing in >75% of patients in the appropriate patient population performed specifically for assessing AD [33]. CTA Chest, Abdomen, and Pelvis With IV Contrast CTA of the chest, abdomen, and pelvis allows for imaging of both the thoracic and abdominal aorta, and it provides assessment of extension of the dissection along the thoracic, abdominal, and pelvic branch vessels with one injection of IV contrast and a single breath-hold acquisition. Postprocessing of the volumetric data set, using multiplanar reformatting and 3-D volume rendering, facilitates evaluation of the location and course of the intimal flap [34], branch vessel, and visceral organ involvement.
Suspected Acute Aortic Syndrome. One multidetector CT study enrolling 57 patients has reported sensitivities and specificities of 100% [22]. CT findings may also be used to predict patient outcome. For example, in one retrospective study of 83 patients with type B dissections, the morphologic features of a dissection were associated with an increase in late adverse events [27]. CTA with IV contrast also enables detection of focal intimal disruptions or also ulcer-like projections as prognostic indicators in IMH. In one study of 107 patients, aorta-related death or need for invasive surgery was increased when focal intimal disruptions or ulcer-like projections were present (hazard ratio, 24.43) [29]. CTA with IV contrast can be used to diagnose penetrating PAU, but contrast does not enable additional prognostic imaging findings. PAU prognosis has been associated with the presence or absence of aortic rupture, but in one study, aortic diameter, ulcer size, or the presence of IMH did not affect prognosis [30]. Compared with CTA chest, TRO CT protocols can be used to assess for additional, potentially fatal possibilities such as pulmonary embolism and acute coronary syndrome [31,32]. It has been reported that TRO CT can safely eliminate further diagnostic testing in >75% of patients in the appropriate patient population performed specifically for assessing AD [33]. CTA Chest, Abdomen, and Pelvis With IV Contrast CTA of the chest, abdomen, and pelvis allows for imaging of both the thoracic and abdominal aorta, and it provides assessment of extension of the dissection along the thoracic, abdominal, and pelvic branch vessels with one injection of IV contrast and a single breath-hold acquisition. Postprocessing of the volumetric data set, using multiplanar reformatting and 3-D volume rendering, facilitates evaluation of the location and course of the intimal flap [34], branch vessel, and visceral organ involvement.