Freezing motions of the intimal flap after acute aortic dissection with ECG-gated CT angiography

CT angiography is the gold standard imaging modality in acute aortic dissection. Recent achievements in technology made image acquisition quick enough for the ECG-gated angiography of the whole aorta during one breath-hold. Latest versions of iterative image reconstruction algorithms and low-noise x-ray detectors resulted in significant dose and/or image noise reduction, both being comparable to conventional non-ECG-gated scans (1). This huge progression in non-invasive diagnostic testing allows us to clearly visualize the undulating intimal flap in acute aortic dissection and to accurately assess side-branch involvement and ostial anatomy (2). Understanding the motion characteristics of the intimal septum is fundamental in the planning of targeted interventions which can lead to better prognosis. In this collage, we demonstrate the typical patterns of intimomedial membrane motion at those specific levels of the thoracic and abdominal aorta requiring special attention when evaluating acute aortic dissection with ECG-gated CT angiography