From the Department of Radiology, NYU Langone Health, 660 First Ave, Room 747, New York, NY 10016 (J.P.K., J.M.G., L.A.L., L.A., E.K.G., W.M.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (S.P.); and Department of Radiology, Mater Misericordiae University Hospital, Dublin, Ireland (B.H.).
Radiographics. 2021 Mar-Apr;41(2):399-424. doi: 10.1148/rg.2021200055.
Chest CT angiography (CTA) is essential in the diagnosis of acute aortic syndromes. Chest CTA quality can be optimized with attention to technical parameters pertaining to noncontrast imaging, timing of contrast-enhanced imaging, contrast material volume, kilovolt potential, tube-current modulation, and decisions regarding electrocardiographic-gating and ultra-fast imaging, which may affect the accurate diagnosis of acute aortic syndromes. An understanding of methods to apply to address suboptimal image quality is useful, as the accurate identification of acute aortic syndromes is essential for appropriate patient management. Acute aortic syndromes have high morbidity and mortality, particularly when involving the ascending aorta, and include classic aortic dissection, penetrating atherosclerotic ulcer, and acute intramural hematoma. An understanding of the pathogenesis and distinguishing imaging features of acute aortic syndromes and aortic rupture and some less common manifestations is helpful when interpreting imaging examinations. Related entities, such as ulcerated plaque, ulcerlike projections, and intramural blood pools, and mimics, such as vasculitis and aortic thrombus, are important to recognize; knowledge of these is important to avoid interpretive pitfalls. In addition, an awareness of postsurgical aortic changes can be useful when interpreting CTA examinations when patient history is incomplete. The authors review technical considerations when performing CTA, discuss acute aortic syndromes, and highlight diagnostic challenges encountered when interpreting aortic CTA examinations. RSNA, 2021.
胸部 CT 血管造影（CTA）是急性主动脉综合征诊断的重要手段。关注非对比成像的技术参数、对比增强成像的时间、对比剂用量、千伏电位、管电流调制，以及心电图门控和超快成像的决策，可以优化胸部 CTA 的质量，这可能会影响急性主动脉综合征的准确诊断。了解如何解决图像质量不佳的方法是有用的，因为准确识别急性主动脉综合征对于患者的适当管理至关重要。急性主动脉综合征发病率和死亡率较高，尤其是涉及升主动脉时，包括典型的主动脉夹层、穿透性动脉粥样硬化性溃疡和急性壁内血肿。在解读影像学检查时，了解急性主动脉综合征和主动脉破裂以及一些不太常见表现的发病机制和影像学特征的区别有助于诊断。了解相关实体，如溃疡性斑块、溃疡样突起和壁内血肿池，以及类似物，如血管炎和主动脉血栓，对于避免解释陷阱很重要。此外，当患者病史不完整时，了解术后主动脉变化在解读 CTA 检查时可能会有所帮助。作者回顾了进行 CTA 时的技术注意事项，讨论了急性主动脉综合征，并强调了在解读主动脉 CTA 检查时遇到的诊断挑战。RSNA，2021 年。
