Abstract
AimsConventional computed tomography (CT) approaches provides limited visualization of the entire endoluminal changes of aortic dissection (AD), which is essential for its treatment. As an important supplement, three-dimensional CT virtual intravascular endoscopy (VIE) can show relevant details. This study aims to determine the value of VIE in displaying the entry tear and intimal flap of AD.Methods and ResultsAmong 127 consecutive symptomatic patients with suspected AD who underwent CT angiography (CTA), 84 subjects were confirmed to have AD and were included in the study. Conventional CT and VIE images were observed and evaluated. From the 92 entry tears revealed via conventional CT, 88 (95.7%) tears appeared on VIE with round (n = 26), slit-shaped (n = 9), or irregular (n = 53) shapes, whereas the intimal flaps were sheetlike (n = 34), tubular (n = 34), wavelike (n = 13), or irregular (n = 7) in shape. The VIE also showed the spatial relationship between the torn flap and adjacent structures. Among 58 entry tears with multiple-line type flap shown on conventional CT, 41 (70.7%) appeared with an irregular shape on VIE, whereas among 30 tears with single-line type flap, 17 (56.7%) appeared as round or slit-shaped on VIE. These results demonstrated a significant difference (P < 0.05). The poor display of tears on VIE was related to the low CT attenuation values in lumen or in neighboring artifacts (P < 0.01).ConclusionCT VIE presents the complete configurations and details of the intimal tears and flaps of AD better than conventional CT approaches. Accordingly, it should be recommended as a necessary assessment tool for endovascular therapy and as part of strategy planning in pre-surgical patients.
Highlights
With the increasing prevalence of minimally invasive treatment approaches for aortic dissection (AD), endovascular stent-graft implantation has become widely accepted as a good alternative to traditional surgical repair [1,2,3], which requires accurate localization of an intimal tear site [4]
From the 92 entry tears revealed via conventional computed tomography (CT), 88 (95.7%) tears appeared on virtual intravascular endoscopy (VIE) with round (n = 26), slitshaped (n = 9), or irregular (n = 53) shapes, whereas the intimal flaps were sheetlike (n = 34), tubular (n = 34), wavelike (n = 13), or irregular (n = 7) in shape
The VIE showed the spatial relationship between the torn flap and adjacent structures
Summary
With the increasing prevalence of minimally invasive treatment approaches for aortic dissection (AD), endovascular stent-graft implantation has become widely accepted as a good alternative to traditional surgical repair [1,2,3], which requires accurate localization of an intimal tear site [4]. Over the last several years, multi-slice computed tomography (CT) has become a crucial technology in the diagnosis and assessment of AD This technique exhibits higher reliability and feasibility than magnetic resonance imaging and transesophageal echocardiography [7,8,9]. Available guidelines for diagnosis are based on conventional CT approaches, which typically include axial imaging supplemented with two-dimensional (2D) or three-dimensional (3D) reconstructions. Such reconstructions consist of multiplanar reformation (MPR), maximum intensity projection (MIP), and volume rendering (VR) [10,11,12]. The present study aims to evaluate the value of VIE in imaging 3D endovascular changes in patients with AD prior to surgical or endovascular procedures, as well as to investigate the factors that influence VIE display
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