Document Assessment
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Document Follow-Up Imaging (Figures 14&16):
➤ A significant % of patients with aortic dissection, regardless of initial
treatment modality, will develop aneurysmal growth during the next 5
years, making surveillance in this population of prime importance.
➤ In the absence of contraindications, multiphasic CTA, which includes
nonenhanced, arterial-phase, and delayed images, is the imaging
modality of choice.
➤ Radiology studies obtained should report the result of the initial
management chosen, describe any changes in relation to baseline
and subsequent scans, and report the presence of any new pathologic
change.
Imaging Parameters
Dissection extent: Healing or progression of dissection
• Status of involved aortic zones
▶ Patent, partially thrombosed, or completely thrombosed false lumen
▶ Additional propagation or resolution
False lumen patency status:
• Patent, partially thrombosed, or completely thrombosed false lumen
• The entirety of the dissection process must be documented, zone by zone.
Aortic measurements:
• Use sequential CTA or MRA comparisons
• Diameter [Figure 6, 16]
▶ from outer aortic wall to outer aortic wall
▶ perpendicular to the angle of blood flow (centerline technique)
▶ at levels of interest
• Volume
▶ true lumen, false lumen, and entire aorta at specific levels
• Aortic remodeling
▶ False lumen reduction in maximal diameter or volume and no growth in total
aortic diameter or volume
▶ True lumen expansion in maximal diameter or volume and no growth in total
aortic diameter or volume
▶ Total aortic maximal diameter reduction with variable changes in true and false
lumen diameters
The term positive aortic remodeling may be used only to describe an aorta that
demonstrates at least one of the above changes. For instance, an aortic dissection
post-TEVAR may have resolution of the dissection in zones 3–4 (positive aortic
remodeling ) yet have growth in the false lumen in zones 6–8 (negative aortic
remodeling ). Both must be documented.
• Accurately describe the number and percentage of patients in a population who
demonstrate growth and the distribution of zones where growth is observed.
