Contrast-enhanced ultrasound versus conventional ultrasound and MS-CT in the diagnosis of abdominal aortic dissection

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To evaluate the diagnostic results of different ultrasound techniques: B-scan, color-coded Doppler sonography (CCDS) and contrast-enhanced ultrasound in the diagnosis of abdominal aortic dissection in comparison to multislice computed tomography (MS-CT). Between March 2006 and December 2008, 35 patients (28 males, 7 females) with a mean age of 58 years (range 37-87 years) with abdominal aortic dissection and 15 patients (11 males, 4 females) with a mean age of 53 years (range 42-78 years) without abdominal aortic dissection as a control group were examined with B-scan, CCDS and contrast-enhanced ultrasound (CEUS) after injection of 1.0-1.2 cc of SonoVue (Bracco, Italy). The examinations were performed using a Sequoia 512 (Siemens/Acuson, Mountain View) system with CPS software. Standardized MS-CTA using a 16 or 64 row scanner (Somatom Sensation 16 or 64, Siemens Medical Systems, Forchheim, Germany) served as the reference standard. The sensitivity of B-scan and CCDS for detecting abdominal aortic dissections were both 23/35 (68%); for contrast-enhanced ultrasound it was 34/35 (97%). Dissection membrane, differentiation of true and false lumen and flow direction within the true and false lumen were better detected by CEUS than by CCDS. The lack of angle dependence of the US probe and lack of flow and pulsations artifacts in CEUS made the examination procedure easier. All findings were confirmed by MS-CT. With contrast-enhanced ultrasound, diagnostic accuracy sensitivity and specificity for the diagnosis of abdominal aortic dissections is improved as compared to B-scan and CCDS. Dissection membrane and flow within the true and false lumen are clearly differentiated by CEUS. Thus CEUS is a promising alternative for patients whose condition does not allow an examination by CTA.