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

21 Scopus citations

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

Funding

Activities not related to the present article: disclosed no relevant relationships. Other relationships: disclosed no relevant relationships. B.D.A. Activities related to the present article: author’s institution has research grant from the American Heart Association. Activities not related to the present article: author received consultancy fee from Tempus Laboratory for expert image segmentation; author has Dixon translational research grant from Northwestern University and SCMR Seed Grant from Society for Cardiovascular Magnetic Resonance; author received payment from Medscape for development of educational presentations. Other relationships: disclosed no relevant relationships. Disclosures of Conflicts of Interest: Z.A.Z. disclosed no relevant relationships. A.B. disclosed no relevant relationships. S.C.M. disclosed no relevant relationships. A.W.H. disclosed no relevant relationships. C.K.M. disclosed no relevant relationships. P.V. disclosed no relevant relationships. N.S.B. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author’s institution receives royalties from and has patent pending with Imbio. Other relationships: disclosed no relevant relationships. A.R.A. disclosed no relevant relationships. J.D.C. Activities related to the present article: disclosed no relevant relationships. Activities not related to the present article: author’s institution has an investigator-initiated grant from Siemens Healthineers, not related to this work.; author received travel funding from Siemens Health-ineers to attend a research summit between Mayo Clinic CT Innovation Center and Siemens Healthineers. Other relationships: disclosed no relevant relationships. C.J.F. Activities related to the present article: author is an associate editor

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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