Department of Cardiology, Hospital Vall d'Hebron, P° Vall d'Hebron 119, 08035 Barcelona, Spain.
Nat Rev Cardiol. 2013 Aug;10(8):477-86. doi: 10.1038/nrcardio.2013.92. Epub 2013 Jun 25.
The term acute aortic syndrome (AAS) incorporates aortic dissection, intramural haematoma, and penetrating atherosclerotic ulcer. The common feature of these entities is disruption of the medial layer of the aortic wall. Owing to the life-threatening nature of these conditions, prompt and accurate diagnosis is of paramount importance--misdiagnosis can be fatal. The noninvasive imaging techniques that have a fundamental role in the diagnosis and management of patients with AAS include CT, MRI, transoesophageal echocardiography (TEE), and transthoracic echocardiography (TTE). CT is the most-commonly used imaging modality owing to its wide availability, accuracy, and large field of view. CT plus TTE is the best combination for diagnosing AAS and its complications, and allows important morphological and dynamic aspects of AAS to be assessed and appropriately managed. Ideally, TEE should be performed immediately before surgery or endovascular treatment, in the operating theatre and under general anaesthesia. In stable patients with an uncertain diagnosis of intramural haematoma despite high clinical suspicion, MRI is the technique of choice to make a definitive diagnosis. Imaging techniques have an important role in the primary diagnosis, treatment strategy, and risk stratification of patients with AAS.
急性主动脉综合征（AAS）包括主动脉夹层、壁内血肿和穿透性动脉粥样硬化性溃疡。这些病变的共同特征是主动脉壁中层破裂。由于这些病症具有威胁生命的性质，因此快速准确的诊断至关重要——误诊可能是致命的。在 AAS 患者的诊断和管理中具有重要作用的无创影像学技术包括 CT、MRI、经食管超声心动图（TEE）和经胸超声心动图（TTE）。由于其广泛的可用性、准确性和大视野，CT 是最常用的成像方式。CT 加 TTE 是诊断 AAS 及其并发症的最佳组合，可评估 AAS 的重要形态和动态方面，并进行适当的管理。理想情况下，TEE 应在手术或血管内治疗前、手术室中和全身麻醉下立即进行。对于临床高度怀疑但尽管存在不确定的壁内血肿诊断的稳定患者，MRI 是做出明确诊断的首选技术。影像学技术在 AAS 患者的初步诊断、治疗策略和风险分层中具有重要作用。
