Assessment Of The Coronary Arteries

In patients with type A dissection, assessment of the coronary arteries is important. As mentioned above, published research about CT evaluation of aortic dissection is currently limited to single slice CT, an insufficient technique for evaluation of the coronaries. However, multidetector CT with cardiac gating is now widely available and has shown to be accurate and reliable for evaluation of coronary artery stenoses37-41. Recent case reports demonstrate the potential of multidetector CT for assessment of the coronary arteries in type A

Figure 5.14. Axial contrast-enhanced CT image of classic dissection. The white arrow indicates the false lumen. Note the acute angle between the dissection flap and the outer aortic wall of the false lumen (black arrowheads).
Figure 5.15. Axial contrast-enhanced CT image of classic dissection demonstrates cobwebs in the false lumen (black arrow).

dissection42,43. However, TEE and not CT is currently the method of choice for evaluation of the proximal coronary arteries. This may soon change with the proliferation of 16 and greater row MDCT scanners. Figure 5.13 shows images of type A dissection, demonstrating accurate delineation of the dissection flap as well as the origins of the aortic arch vessels and the left main coronary artery.

Figure 5.16. Axial contrast-enhanced CT image of classic dissection demonstrates calcification of the dissection flap and the outer wall of the true lumen (black arrows).

Figure 5.17. Axial CT images of chronic classic dissection demonstrates calcification of the dissection flap and the outer wall of the false lumen (black arrows in (a) and (b): (a) unen-hanced image; (b) contrast-enhanced image (note low attenuation of the false lumen on the contrast-enhanced image due to slow flow and early image acquisition).

Figure 5.17. Axial CT images of chronic classic dissection demonstrates calcification of the dissection flap and the outer wall of the false lumen (black arrows in (a) and (b): (a) unen-hanced image; (b) contrast-enhanced image (note low attenuation of the false lumen on the contrast-enhanced image due to slow flow and early image acquisition).

0 0

Responses

  • tricia
    How to assess coronaries with type I dissection?
    16 days ago

Post a comment