Three-Dimensional Visualization and Imaging of the Entry Tear and Intimal Flap of Aortic Dissection Using CT Virtual Intravascular Endoscopy

• Published in: PloS one Vol. 11; no. 10; p. e0164750
• Main Authors: Qi, Yafei, Ma, Xiaoyuan, Li, Gang, Ma, Xiangxing, Wang, Qing, Yu, Dexin
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 19.10.2016; Public Library of Science (PLoS)
• Subjects: Adult; Advertising executives; Aged; Aneurysm, Dissecting - diagnostic imaging; Aneurysms; Angiography; Aorta; Aortic Aneurysm - diagnostic imaging; Aortic dissection; Biology and Life Sciences; Cardiovascular disease; Cardiovascular system; CAT scans; Computed tomography; Coronary vessels; Dissection; Endoscopes; Endoscopy; Engineering and Technology; Female; Flaps; Hospitals; Humans; Imaging, Three-Dimensional; Injuries; Male; Medical imaging; Medicine and Health Sciences; Middle Aged; NMR; Nuclear magnetic resonance; Patients; Research and Analysis Methods; Surgery; Surgical instruments; Tearing; Tomography, X-Ray Computed; Tunica Intima - diagnostic imaging; Type 2 diabetes; Vascular surgery; Visualization; Work stations; China
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0164750

Conventional computed tomography (CT) approaches provides limited visualization of the entire endoluminal changes of aortic dissection (AD), which is essential for its treatment. As an important supplement, three-dimensional CT virtual intravascular endoscopy (VIE) can show relevant details. This study aims to determine the value of VIE in displaying the entry tear and intimal flap of AD. Among 127 consecutive symptomatic patients with suspected AD who underwent CT angiography (CTA), 84 subjects were confirmed to have AD and were included in the study. Conventional CT and VIE images were observed and evaluated. From the 92 entry tears revealed via conventional CT, 88 (95.7%) tears appeared on VIE with round (n = 26), slit-shaped (n = 9), or irregular (n = 53) shapes, whereas the intimal flaps were sheetlike (n = 34), tubular (n = 34), wavelike (n = 13), or irregular (n = 7) in shape. The VIE also showed the spatial relationship between the torn flap and adjacent structures. Among 58 entry tears with multiple-line type flap shown on conventional CT, 41 (70.7%) appeared with an irregular shape on VIE, whereas among 30 tears with single-line type flap, 17 (56.7%) appeared as round or slit-shaped on VIE. These results demonstrated a significant difference (P < 0.05). The poor display of tears on VIE was related to the low CT attenuation values in lumen or in neighboring artifacts (P < 0.01). CT VIE presents the complete configurations and details of the intimal tears and flaps of AD better than conventional CT approaches. Accordingly, it should be recommended as a necessary assessment tool for endovascular therapy and as part of strategy planning in pre-surgical patients.