Computed Tomography Criteria for Differential Evaluation of True and False Lumens in Aortic Dissection

The aim of study Based on computed tomography data, to determine the most characteristic criteria for true lumen (TL) and false lumen (FL) in aortic dissection. To identify the relationship of the studied features with the stage of aortic dissection.
Materials of the study Computed tomography (CT) data of 115 patients diagnosed with aortic dissection (AD) who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The average age of the patients was 54.5 years (median — 56 years), men predominated in the studied group. AD types according to the De Bakey classification were distributed as follows: Type I — in 47% of patients, Type II — in 16.5%, Type III — in 36.5%. Dissection in the acute stage occurred in 62% of the patient, in the subacute — in 16%, in the chronic — 22%.
Results In the studied group, FL in all cases prevailed over the TL by size, regardless of the stage and type of AD. Analysis of lumen ratio showed that in 63.55% of patients, FL occupied 75% or more of the aortic cross-sectional area. Location of FL: at the level of the ascending aorta, along the right and anterior walls of the aorta — 94.5%; in the descending thoracic aorta, along the posterior and left walls — 84%; in the abdominal aorta, along the posterior and left walls — 70%. Calcifications of the non- dissected part of the aortic wall, as a sign of a true lumen, were found in 59.1%. There was no correlation between calcification and the AD stage. Partial thrombosis of one of the lumens was detected in 59% (in FL — 85%, in TL — 13%, thrombosis of both lumens — 2%). The beak signs occurred in 85% of patients with AD, however, it was significantly more often detected in patients with acute and subacute AD stages than in the chronic stage (p<0.001). The cobweb sign was found in one third of patients with AD, however, it was statistically significantly more often determined in patients in acute and subacute stages (p<0.05).
Conclusion CT is reasonably considered a highly informative method of diagnosing AD. The signs of true and false lumen presented in the work, as well as their combination, make it possible to perform a quick and error-free marking of the aortic lumen with a high degree of probability. A number of the described CT signs correlate with the stage of AD.

1. Valente T, Rossi G, Lassandro F, Rea G, Marino M, Muto M, et al. MDCT evaluation of acute aortic syndrome (AAS). Br J Radiol. 2016; 89(1061):20150825. PMID:27033344 https://doi.org/10.1259/bjr.20150825

2. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: executive summary. J Am Coll Cardiol. 2010;55(14):1509–1544. https://doi.org/10.1016/j.jacc.2010.02.010

3. Belov IuV, Charchian ÉR, Stepanenko AB, Gens AP, Khachatryan ZR. Surgical treatment of DeBakey type 1 aortic dissection. Pirogov Russian Journal of Surgery. 2018;(7):8–17. (in Russ.). https://doi.org/10.17116/hirurgia201878

4. Mussa FF, Horton JD, Moridzadeh R, Nicholson J, Trimarchi S, Eagle KA. Acute Aortic Dissection and Intramural Hematoma. JAMA. 2016;316(7):754–763. PMID:27533160 https://doi.org/10.1001/jama.2016.10026

5. Vishniakova MV jr, Shumsky VI, Vishniakova MV, Denisova LB. Multidetector Computer Tomography in Aortic Dissection Diagnosis. Russian Electronic Journal of Radiology. 2013;3(1):50–57. (in Russ.).

6. Valente T, Rossi G, Lassandro F, Marino M, Tortora G, Muto R, et al. MDCT in diagnosing acute aortic syndromes: reviewing common and less common CT findings. Radiol Med. 2012;117(3):393–409. PMID:22095416 https://doi.org/10.1007/s11547-011-0747-9

7. Chiu KW, Lakshminarayan R, Ettles DF. Acute aortic syndrome: CT findings. Clin Radiol. 2013;68(7):741–748. PMID:23582433 https://doi.org/10.1016/j.crad.2013.03.001

8. Yoo SM, Lee HY, White CS. MDCT evaluation of acute aortic syndrome. Radiol Clin North Am. 2010;48(1):67–83. PMID:19995630 https://doi.org/10.1016/j.rcl.2009.09.006

9. Ueda T, Chin A, Petrovitch I, Fleischmann D. A pictorial review of acute aortic syndrome: discriminating and overlapping features as revealed by ECG-gated multidetector-row CT angiography. Insights Imaging. 2012;3(6):561–571. PMID:23129238 https://doi.org/10.1007/s13244-012-0195-7

10. DeBakey ME, McCollum CH, Crawford ES, Morris GC Jr, Howell J, Noon GP, et al. Dissection and dissecting aneurysms of the aorta: Twenty-year follow-up of five hundred twenty-seven patient treated surgically. Surgery. 1982;92(6):1118–1134. PMID:7147190

11. Isselbacher EM, Eagle KA, DeSanctis RW. Diseases of the aorta. In: Braunwald E. (ed). Heart Disease. A Textbook of Cardiovascular Medicine. 5th ed. Pheladelphia: W.B. Saunders Company; 1997. p. 1546–1581.

12. Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE. Management of acute aortic dissections. Ann Thorac Surg. 1970;10(3):237–247. PMID:5458238 https://doi.org/10.1016/S0003-4975(10)65594-4

13. Habib G, Lancellotti P, Antunes M, Bongiorni M, Casalta J, Zotti F, et al. 2015 ESC Guidelines for the Management of Infective Endocarditis. Russian Journal of Cardiology. 2016;(5):65–116. (in Russ.) https://doi.org/10.15829/1560-4071-2016-5-65-116

14. LePage MA, Quint LE, Sonnad SS, Deeb GM, Williams DM. Aortic dissection: CT features that distinguish true lumen from false lumen. AJR Am J Roentgenol. 2001;177(1):207–211. PMID:11418429 https://doi.org/10.2214/ajr.177.1.1770207

15. Lee DY, Williams DM, Abrams GD. The dissected aorta: part II. Differentiation of the true from the false lumen with intravascular US. Radiology. 1997;203(1):32–36. PMID:9122413 https://doi.org/10.1148/radiology.203.1.9122413

16. Evangelista A, Salas A, Ribera A, Ferreira-González I, Cuellar H, Pineda V, et al. Long-Term Outcome of Aortic Dissection with Patent False Lumen Predictive Role of Entry Tear Size and Location. Circulation. 2012;125(25):3133–3141. PMID:22615344 https://doi.org/10.1161/CIRCULATIONAHA.111.090266

17. Tsai TT, Evangelista A, Nienaber CA, Myrmel T, Meinhardt G, Cooper JV, et al.; International Registry of Acute Aortic Dissection. Partial thrombosis of the false lumen in patients with acute type B aortic dissection. N Engl J Med. 2007;357(4):349–359. PMID:17652650 https://doi.org/10.1056/NEJMoa063232

18. Evangelista A, Maldonado G, Gruosso D, Teixido G, RodríguezPalomares J, Eagle K. Insights from the International Registry of Acute Aortic Dissection. Glob Cardiol Sci Pract. 2016;2016(1):e201608. PMID:29043258 https://doi.org/10.21542/gcsp.2016.8

19. Cooper M, Hicks C, Ratchford EV, Salameh MJ, Malas M. Diagnosis and treatment of uncomplicated type B aortic dissection. Vasc Med. 2016;21(6):547–552. PMID:27126951 https://doi.org/10.1177/1358863X16643601

20. Hahn LD, Mistelbauer G, Higashigaito K, Koci M, Willemink MJ, Sailer AM, et al. CT-based True- and False-Lumen Segmentation in Type B Aortic Dissection Using Machine Learning. Radiol Cardiothorac Imaging. 2020;2(3):e190179. PMID:33778582 https://doi.org/10.1148/ryct.2020190179eCollection 2020.

21. Kurugol S, San Jose Estepar R, Ross J, Washko GR. Aorta segmentation with a 3D level set approach and quantification of aortic calcifications in noncontrast chest CT. Annu Int Conf IEEE Eng Med Biol Soc. 2012;2012:2343–2346. PMID:23366394 https://doi.org/10.1109/EMBC.2012.6346433

22. Xie Y, Padgett J, Biancardi AM, Reeves AP. Automated aorta segmentation in low-dose chest CT images. Int J Comput Assist Radiol Surg. 2014;9(2):211–219. PMID:23877280 https://doi.org/10.1007/s11548-013-0924-5

23. Pfeffer Y, Mayer A, Zholkover A, Konen E. A system for automatic aorta sections measurements on chest CT. In: Tourassi GD, Armato SG, (eds.). Proceedings of SPIE. 2016. Vol. 9785. Medical imaging 2016: computeraided diagnosis. p.978505. https://doi.org/10.1117/12.2217566

24. Krissian K, Carreira JM, Esclarin J, Maynar M. Semi-automatic segmentation and detection of aorta dissection wall in MDCT angiography. Med Image Anal. 2014;18(1):83–102. PMID:24161795 https://doi.org/10.1016/j.media.2013.09.004