Why the study?
Early diagnosis of aortic dissection and end-organ malperfusion is critical for management and prognosis, prompting evaluation of aortic dynamic CT angiography for diagnosis and abdominal organ perfusion assessment.
Does dynamic computed tomographic angiography improve the diagnosis of rupture and end-organ malperfusion compared to conventional CTA in patients with aortic dissection?
Does dynamic computed tomographic angiography improve the diagnosis of rupture and end-organ malperfusion compared to conventional CTA in patients with aortic dissection?
Dynamic CTA provides a slightly better diagnostic rate for aortic rupture than conventional CTA and can assess end-organ malperfusion such as renal injury.
Dynamic CTA may aid AD diagnosis and malperfusion assessment; hypothesis-generating, prospective validation needed before practice change.
Purpose: Early diagnosis of aortic dissection (AD) and end-organ malperfusion is of great significance for AD’s management and prognosis. This study aimed to evaluate the use of aortic dynamic computed tomography (CT) angiography (CTA) in diagnosing AD and the significance of evaluating blood supply to abdominal organs. Methods: The patients with confirmed AD and who visited our hospital from 12/2018 to 12/2019 were retrospectively included. The densities of the aortas and abdominal organs were measured, and a time-density curve was drawn and compared with conventional CTA. Correlation analysis was performed between the changes of densities in the false lumen and the changes of densities in injured kidneys. Results:Fifty patients were included. The tears were seen in 86%. The main aortic branches were involved in 48%. The diagnostic rate of dynamic angiography for rupture was 86%, slightly better than aortic CTA (84%, P<0.01; κ=0.765). The density of the true and false lumens was measured in each phase: phase 2 (4%), 3 (4%), 4 (48%), 5 (26%), and 6 (16%). Eighteen patients had single renal artery involvement. In phase 7, the density of the AD false lumen and kidney damage were correlated (r=0.75, P<0.001). Conclusions: Dynamic angiography can show the fine structures of AD. In dynamic angiography, the best phase can be selected according to the hemodynamic changes of patients to complete the diagnosis. False lumen density in phase 7 was correlated with renal injury.
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Song et al. (2022) studied this question.
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