New Ways to Detect Aortic Dissection
The May issue of The Journal of Nuclear Medicine has two articles offering new techniques to detect aortic dissection. Distinguishing between acute and chronic aortic dissection rapidly and accurately is critical for treatment decisions. Also, acute aortic dissection is the tenth leading cause of death in the Western world, making diagnosis all the more important.
The paper “Imaging of Acute and Chronic Aortic Dissection by 18F-FDG PET/CT” presents a technique that combines positron emission tomography (PET) scanning with the imaging agent fluorodeoxyglucose (FDG) to help determine the age of an aortic dissection, as well as how risky the dissection is. This in turn helps gauge the need for surgery, which can be lifesaving.
In disorders such as Marfan Syndrome, the aorta may weaken, leading to the possibility of dissection, or a tear in the inner wall of this massive blood vessel. The tear allows blood to build up between the the layers of the aortic wall, leading to an aneurysm that can burst, leading to sudden death.
Conventional imaging techniques, such as ultrasound, cannot readily differentiate between acute and chronic dissection, whereas the new technique in the paper mentioned above reports on successful use in two studies.
A separate paper called “Uptake of F-18 Fluorodeoxyglucose in Acute Aortic Dissection; a Determinant of Unfavorable Outcome” reports on an association between greater metabolic activity and increased risk of rupture. The Japanese researchers behind this paper hope that this approach will help in evaluating the extent and risk of aortic aneurysm.
At present aortic dissection is often diagnosed during autopsy, as symptoms may be too vague or diffuse to gain attention. Or it may be discovered incidentcally, as reported in the article “Chronic type A aortic dissection incidentally detected in a 71 year old woman.” In Marfan Syndrome and other patients, aortic dissection is screened for based on risk factors, so new ways to detect aortic dissection can only help in preventing death.
Earlier this month the New England Journal of Medicine had an article entitled “Endovascular versus Open Repair of Abdominal Aortic Aneurysm” which looked at the long-term outcome of endovascular versus open repair in abdominal aortic aneurysms. The article concluded that endovascular repair saw fewer deaths during surgery, but no difference in anuerysm-related mortality or total mortality in the long term. On the Johns Hopkins Podblog, the two commentators both said they would choose open repair over endovascular repair.
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