State-of-the-Art Imaging of the Aorta with Respect to Endoluminal Intervention
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REVIEW
State-of-the-Art Imaging of the Aorta with Respect to Endoluminal Intervention Go¨tz M. Richter1
Received: 11 May 2020 / Accepted: 5 October 2020 Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2020
Abstract Acute aortic syndrome, aortic aneurysm and stenotic aortic disease are significant challenges for stateof-the art imaging of the aorta. Over the last decade, advanced imaging methods such as multidetector computed tomography, high-resolution ultrasound including color-coded Doppler and contrast-enhanced B-mode imaging and magnetic resonance imaging have assumed an important role in identifying and describing many of the complex aortic pathologies. They play a fundamental role in decision making for treatment such as endovascular, or open surgical or conservative treatment. In this overview, a systematic description of all present imaging modalities is presented and their respective roles for the entire spectrum of aortic diseases are illustrated and defined in their relevance. Furthermore, future aspects such as virtual reality methods are presented. Keywords Acute aortic syndrome Aortic dissection Aortic aneurysm Imaging of the aorta
Introduction The aim and scope of this article is to provide the reader with an up-to-date and comprehensive overview of the various imaging modalities which are currently used for diagnostic imaging of the aorta in the context of endoluminal treatment concepts. The first part describes the basic principles of the present imaging modalities, the second & Go¨tz M. Richter [email protected] 1
Klinikum Stuttgart, Kriegsbergstr. 60, 70174 Stuttgart, Germany
part describes the types of aortic diseases for which endovascular techniques have a high relevance, and the third part discusses the emerging role of augmented or virtual reality with special focus on reduction in radiation dose, use of contrast material and working time.
Imaging Modalities Conventional Radiography Conventional radiography only plays a minor role in aortic diseases. X-ray images of the chest or abdomen are usually performed for reasons unrelated to the diagnosis of aortic disease. Conventional chest imaging is of primary interest in traumatic injuries of the thoracic aorta (Fig. 1) and also plays a role in the follow-up after TEVAR in identifying possible late fractures of the stent graft scaffold, secondary kinks or migration. Conventional abdominal imaging might be specifically performed also in the follow-up after EVAR and was part of the diagnostic algorithm for post-treatment studies with respect to potential late conformation changes, such as stent fractures or graft dislodgements similar to after TEVAR. Ultrasound Particularly for aneurysm of the abdominal aorta, ultrasound is the main primary imaging tool. In several European countries, it is even accepted as a screening modality (see below) because it is low cost, easy to perform and readily available. It is useful to measure
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