Imaging and Surveillance of Chronic Aortic Dissection: Current Practice and Future Directions.

Abstract

Chronic aortic dissection is a complex disease with a heterogenous clinical course. Specialised imaging is necessary for the long-term surveillance of this disease to identify patients who meet the criteria for intervention, and to monitor surgically treated patients for complications. Whilst computed tomography and magnetic resonance imaging are the most widely utilised modalities, providing a high degree of anatomical detail and reproducible aortic measurements, they are not without significant limitations. These techniques cannot accurately predict patients that are at risk of late complications who may benefit from early intervention. Emerging techniques such as four-dimensional magnetic resonance imaging and computational fluid dynamics have identified multiple haemodynamic variables with potential prognostic value for identifying adverse events such as rupture, malperfusion, or aneurysmal degeneration, and may in the future become integrated into routine clinical practice. This review provides a detailed analysis of current diagnostic and surveillance imaging modalities in chronic aortic dissection and discusses future paradigms in aortic imaging to enable better prognostication and earlier intervention for high-risk patients.