Stellenwert bildgebender Verfahren in der Diagnostik thorakaler Aortenerkrankungen

Abstract

Here we discuss the importance of different noninvasive imaging techniques for the diagnosis of patients with thoracic aortic disease and focus on acute aortic syndrome.

Recent technological advances and access to modern imaging have both improved the likelihood of diagnosing acute aortic conditions.

Moreover, with transesophageal multiplane echocardiography (TEE) and helical computerized tomography (CT) and with magnetic resonance imaging (MRI) the pathophysiologic understanding of these diseases has advanced.

Owing to the high mortality rate of acute aortic syndromes and the importance of early medical and surgical treatment, rapid and accurate diagnostic strategies are essential, especially in critical ill patients.

In clinical practice, transesophageal echocardiography (TEE) and contrast-enhanced computed tomography (CT) are the most frequently utilized imaging modalities.

TEE is precise and rapidly available and has the advantage of mobility (emergency room, intensive care, operating theatre), without the need to transfer a critical patient.

Nevertheless, as a first modality contrast-enhanced helical computerized tomography is most widely used to diagnose acute aortic syndrome. Both CT and MRI provide the most comprehensive information and image all adjacent structures in the chest besides vascular complications of aortic dissection. MRI is rarely used in emergency settings, but is very usefull for following chronic conditions or congenital aortic disease.

In any event, the risk and the time lost by performing several tests should be weighed against any potential incremental information gain. Nevertheless, the use of tomographic diagnostic imaging should be tailored according to the patients hemodynamic conditions and the urgency of treatment in the logistic framework of any given center.

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