Noninvasive morphologic and hemodynamic evaluation of type b aortic dissection: State of the art and future perspectives

Zachary A. Zilber*, Aayush Boddu, S. Chris Malaisrie, Andrew W. Hoel, Christopher K. Mehta, Patricia Vassallo, Nicholas S. Burris, Alejandro Roldán-Alzate, Jeremy D. Collins, Christopher J. François, Bradley D. Allen

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

Abstract

Stanford type B aortic dissection (TBAD) is associated with relatively high rates of morbidity and mortality, and appropriate treatment selection is important for optimizing patient outcomes. Depending on individualized risk factors, clinical presentation, and imaging findings, patients are generally stratified to optimal medical therapy anchored by antihypertensives or thoracic endovascular aortic repair (TEVAR). Using standard anatomic imaging with CT or MRI, several high-risk features including aortic diameter, false lumen (FL) features, size of entry tears, involvement of major aortic branch vessels, or evidence of visceral malperfusion have been used to select patients likely to benefit from TEVAR. However, even with these measures, the number needed to treat for TEVAR remains, and improved risk stratification is needed. Increasingly, the relationship between FL hemodynamics and adverse aortic remodeling in TBAD has been studied, and evolving noninvasive techniques can measure numerous FL hemodynamic parameters that may improve risk stratification. In addition to summarizing the current clinical state of the art for morphologic TBAD evaluation, this review pro-vides a detailed overview of noninvasive methods for TBAD hemodynamics characterization, including computational fluid dynamics and four-dimensional flow MRI.

Original languageEnglish (US)
Article numbere200456
JournalRadiology: Cardiothoracic Imaging
Volume3
Issue number3
DOIs
StatePublished - Jun 2021

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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