Diagnostic performance of MDCT angiography in penetrating atherosclerotic aortic ulcer and its complications compared with digital subtraction angio

Purpose: To evaluate the role of multi-detector CT angiography in acute assessment of patients with acute aortic syndrome (AAS) and discriminating between Intramural hematoma and penetrating atherosclerotic ulcer compared with conventional angiography (CA) as a gold standard technique. Patient and methods: 47 patients were recruited in this prospective study, and contrast-enhanced multi-detector CT angiography examinations were performed from the thoracic inlet to the aortic bifurcation. Results: The mean ulcer diameter was 1.6 cm. The largest number of lesions was in the part of the distal descending aorta below D8. The mean diameter of aorta at level of ulcer was 3.7 cm. Opacification of false lumen was determined in 6 patients. Intramural hematoma was present in 28 patients; it was identified in unenhanced scans as hyper-attenuated mural crescent. The mean length of false lumen was also evaluated for all patients, and it was 16.4 cm. There was a statistically significant correlation between MDCTA and conventional angiography in determining ulcer diameter (p = 0.2359), number (p = 0.5896), location (p = 0.3659), as well as aortic diameter at level of ulcer (p = 0.6398). Conclusion: Multi-detector CT angiography is an accurate, non-invasive tool which has the ability to detect and characterize aortic PAUs correctly and comparable to conventional angiography