Copyright
©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
Significance of an additional unenhanced scan in computed tomography angiography of patients with suspected acute aortic syndrome
Nikolaos Panagiotopoulos, Felix Drüschler, Martin Simon, Florian M Vogt, Sebastian Wolfrum, Steffen Desch, Doreen Richardt, Jörg Barkhausen, Peter Hunold
Nikolaos Panagiotopoulos, Jörg Barkhausen, Peter Hunold, Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck 23538, Germany
Felix Drüschler, Department of Nephrology, University Hospital, Heidelberg 69120, Germany
Martin Simon, Radiologische Allianz, Hamburg 20259, Germany
Florian M Vogt, Radiologie München, München 80331, Germany
Sebastian Wolfrum, Interdisciplinary Emergency Department, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck 23538, Germany
Steffen Desch, Department of Cardiology, Leipzig University, Heart Centre Leipzig, Leipzig 04289, Germany
Doreen Richardt, Department of Cardiac and Thoracic Vascular Surgery, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck 23538, Germany
Author contributions: Hunold P, Vogt FM, Drüschler F designed research; Vogt FM, Drüschler F, Simon M, Hunold P acquired data; Panagiotopoulos N, Vogt FM, Drüschler F, Hunold P analyzed data; Panagiotopoulos N, Hunold P wrote the paper; Barkhausen J, Drüschler F, Simon M, Vogt FM, Wolfrum S, Desch S, Richardt D, Barkhausen J revised and approved final manuscript version
Institutional review board statement: The institutional review board of the University of Lübeck approved this study. This retrospective cohort study and all procedures performed involving human participants were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent statement: All patients gave written informed consent to evaluation and publication of their anonymized data.
Conflict-of-interest statement: None of the authors states a conflict of interest concerning firms and products reported in this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Peter Hunold, MD, Assistant Professor, Vice Chairman, Clinic for Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.
peterhunold@icloud.com
Telephone: +49-451-50017010 Fax: +49-451-50017004
Received: April 30, 2018
Peer-review started: April 30, 2018
First decision: June 14, 2018
Revised: August 30, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: November 28, 2018
Processing time: 225 Days and 6.2 Hours
ARTICLE HIGHLIGHTS
Research background
The life-threatening condition of an intramural hematoma (IMH) is often missed on routinely performed contrast enhanced computed tomography (CT) angiographies (CTA) in patients with suspected acute aortic syndrome (AAS).
Research motivation
To optimize the CT protocol for AAS.
Research objectives
To assess the potential benefit of a CTA protocol that includes an additional unenhanced acquisition added to contrast-enhanced scans in the diagnostic pathway of patients with AAS.
Research methods
Aortic CTA of patients with suspected AAS were retrospectively evaluated for acute aortic dissection, IMH, or penetrating aortic ulcer. The spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If AAS was detected, a venous phase (delay, 90 s) was added. Images were evaluated for the presence and extent of aortic pathologies, and related complications.
Research results
23% of patients with AAS had an IMH. There was no significant difference in the involvement of the ascending aorta or the average age between dissection and IMH. Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH. Subadventitial hematoma involving the pulmonary trunk was present in five patients.
Research conclusions
IMH is a common and difficult to detect entity of AAS. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.
Research perspectives
The results underline the importance of a triphasic CTA as standard diagnostic procedure in patients with suspected AAS.
