Aortic Intimal Tears: Detection with Spiral Computed Tomography

Purpose: To determine the frequency, locations, and sizes of aortic intimal tears detected using spiral computed tomography (CT). Methods: CT scans (26 single detector and 26 multidetector studies) from 52 patients with an unoperated aortic dissection and a patent false lumen were evaluated on a workstation. The number, location, and size of aortic tears were recorded and compared between the following groups: acute and chronic dissection, type A and type B, and single detector and multidetector studies. Results: In 52 patients, 129 tears were identified (mean 2.48 per patient, median 2, range 1–7). There were no significant differences in the number or size of tears between the acute and chronic, the type A and type B, or the single detector and multidetector groups (p<0.05). The most common locations for tears were the descending aorta (57, 44%) and the juxtarenal region (26, 20%). Within the type B category, there was no significant difference in tear locations between the acute and chronic groups (p>0.05). The majority of tears (88, 68%) were <1 cm in each dimension. Tears in the thoracic aorta were significantly larger than abdominal aortic tears (p<0.05). Conclusions: All patients with an aortic dissection and a patent false lumen demonstrated one or more aortic intimal tears using spiral CT. Although most tears were small (<1 cm), they were usually easily visualized.