This has come up in Question 20 from the first paper of 2005, again in Question 13 from the second paper of 2010, and again in Question 24 from the first paper of 2015.The canonical source for this information would have to be the most recent iteration of the ACCF/AHA Guidelines for Diagnosis and Management of Patients With Thoracic Aortic Disease.
Imaging modality | Advantages | Disadvantages |
Aortogram |
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CT |
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MRI |
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TOE |
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CXR |
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Additional information:
- In high risk patients, all the modalities are more or less equal in accuracy
- In moderate risk patients, positive predicitive values are >90% for CT, MRI and TOE but only 65% for aortography
- MRI is the most sensitive of the lot - in low risk patients, it picks up close to 100% of the dissections
- All four modalities have a 85% negative predictive value
The ACCF/AHA guidelines make the following recommendations:
- CT as opposed to echocardiography is the imaging modiality of choice, as it can identify aortic disease but it can also identify disease which mimics aortic disease.
- If repeated imaging is to be performed as surveillance in a stable patient, MRI is recommended (to reduce radiation and contrast exposure)
- CXR is inadequately sensitive and won't reliably exclude dissection in any but the lowest risk patients.
References
A good article on this topic is available:
Khan, Ijaz A., and Chandra K. Nair. "Clinical, diagnostic, and management perspectives of aortic dissection." Chest Journal 122.1 (2002): 311-328.
Nagy, Kimberly, et al. "Guidelines for the diagnosis and management of blunt aortic injury: an EAST Practice Management Guidelines Work Group." Journal of Trauma-Injury, Infection, and Critical Care 48.6 (2000): 1128-1143.