Aortic Disease Assesment By Multidetector CT Aortogram (Pictorial Review).

Abstract

PURPOSE:

To evaluate the reliability of 128-slice Multidetector computed tomographic (MDCT) angiography in differentiating different types of aortic diseases and for preoperative aortic morphologic assessment.

MATERIALS AND METHODS:

116 patients underwent pre-operative CT aortography on 128 slice Toshiba CT scanner in the radiology department of Rehman Medical Institute Peshawar, over a period of one year. With a breath-hold of15 to 20 seconds and 1 or 2 mL/kg (80 to 150 mL) of nonionic contrast by power injector at 3 to 5 mL/s, axial images from above the arch to the femoral arteries were obtained and reconstructed at 0.5mm intervals. ECG gated study was done in those cases having suspicion of aortic root involvement on echocardiography. Pre-contrast scans were obtained in patients with symptoms of acute aortic syndrome. Axial images were reformatted to yield 3-dimensional (3D) images. Images were reviewed on 5.1 vitrea workstation for type and location of pathologic lesions. Imaging findings were compared with surgical findings.

RESULTS:

The types of aortic abnormalities present in the patients included: Coarctation (25%), thoracic aortic aneurysms (22%), Dissections (19%), Thoraco-abdominal diffuse aortic ectasia (2%), Pseudo aneurysms/ Mycotic aneurysms (2%), PDA aneurysms(3%), Interrupted aorta (2%), Right sided aortic arch (2%), Kommerell diverticulum (2%), aortitis (2%), midaortic syndrome (1%) and leriche syndrome(1%). Atherosclerosis was seen in multiple Aortograms. Different anatomical congenital variations were seen; commonest was common origin of right brachiocephalic and left common carotid arteries. Aberrant right subclavian artery was seen in 2 of the cases. Right sided aortic arch was also seen in 2 cases. The accuracy of diagnosis by CT was 100%.

CONCLUSION:

MDCT with the use of multiplanar reconstruction enables highly accurate differentiation among diseases of the aorta.  MDCT angiography with multiplanar and three-dimensional techniques should be the method of choice for preoperative morphologic assessment of aortic diseases in adult patients.

KEYWORDS: 
Aortic diseases, aortic aneurysm, aortic dissection, multidetector CT.