Aortic Disease

Abstract

Computed tomography (CT) is undoubtedly the best imaging modality for the diagnosis, characterization, surveillance, guidance of percutaneous or surgical repair, and postsurgical follow-up of aortic aneurysm (AA). Given that the thoracic aorta size undergoes significant changes during the cardiac circle, end-systolic gated acquisitions are preferred for most accurate measurements. Aside from specific patient populations, asymptomatic ascending aortic aneurysms require surgical repair if ≥55 mm in the ascending aorta and if >55–60 mm in the descending aorta. Current CT protocols for the identification, localization (Stanford classification), and discrimination (aortic dissection, intramural hematoma, and penetrating aortic ulcer) of acute aortic syndromes include an ECG-gated non-contrast acquisition of the thoracic aorta, followed by contrast-enhanced ECG-gated CT angiography in arterial phase from 3 cm above the aortic arch and to the pubis.