Acute Traumatic Aortic Injury: Imaging Evaluation and Management

Stent-graft for treatment of ATAI. (a) Transverse contrast-enhanced multidetector CT scan shows complex tear (arrow) of proximal descending thoracic aorta. (b) Conventional angiogram in left anterior oblique projection following stent-graft deployment shows exclusion of transection from aortic lumen. (Radiology 2008;248:748–762) © RSNA, 2008. All rights reserved. Printed with permission.

Technologic advances, including multidetector CT, are driving significant changes in the imaging evaluation of and treatment for trauma to the aorta. To respond to acute traumatic aortic injury (ATAI), associated with high morbidity and mortality rates, radiologists must understand not only the radiologic perspective but also the pathophysiologic, clinical and surgical perspectives.

In a review in the September issue of Radiology (RSNA.org/radiology), Scott D. Steenburg, M.D., of the Medical University of South Carolina, and colleagues review the historical and current status of imaging and therapy of ATAI. Addressed in the article:

• Pathophysiology and mechanism of injury

• Signs, symptoms and clinical presentation

• Morbidity, mortality and outcome

• Imaging findings, including chest radiography, CT scanning, multidetector CT, MR imaging, conventional angiography, intravascular ultrasound and transesophageal echoaortography

• Treatments, including open thoracotomy and endovascular stent-graft repair

"With improved in-field care and rapid detection and treatment of ATAI, the morbidity and mortality have improved and patients who initially survive are more likely than ever to undergo successful repair," Dr. Steenburg and colleagues write. "It is thus paramount that the radiologist be aware of the wide range of presentations and the various imaging findings of ATAI."


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Cholangiocarcinoma: Current and Novel Imaging Techniques

Mass-forming peripheral cholangiocarcinoma in a 72-year-old woman. (a) Fat-saturated T1-weighted MR image obtained after the intravenous administration of gadolinium-based contrast material shows a heterogeneously enhancing lesion (arrows). (b) On a fat-saturated T1-weighted MR image obtained after the administration of manganese dipyridoxylethylenediamine diacetate bisphosphate, the lesion (arrows) appears hypointense relative to the enhancing liver. The use of this contrast agent increases lesion-liver contrast and lesion conspicuity. (RadioGraphics 2008;28:1263-1287) © RSNA, 2008. All rights reserved. Printed with permission.

An array of modalities are now available to aid in the accurate diagnosis and evaluation of cholangiocarcinomas, which pose a diagnostic and therapeutic challenge with their broad range of histologic types, growth patterns and clinical manifestations, as well as varying imaging manifestations that can overlap those of other hepatobiliary diseases. New imaging tools can also help assess response to novel targeted therapies.

In an article in the September-October issue of RadioGraphics (RSNA.org/radiographics), Nisha I. Sainani, M.D., of Massachusetts General Hospital, and colleagues discuss the role of imaging in the diagnosis, staging and treatment of cholangiocarcinomas and the screening of high-risk individuals. An imaging algorithm for managing cases of known or suspected cholangiocarcinoma is also described. Addressed in the article:

• Noninvasive techniques, including transabdominal ultrasonography, multidetector CT and MR imaging

• Confirmation of diagnosis with direct cholangiography, percutaneous biopsy and endoscopic ultrasound

• Emerging techniques, including positron emission tomography (PET) and PET/CT, portal vein embolization and imaging volumetry, antiangiogenic therapy and imaging, yttrium-90 microspheres and molecular imaging

"The imaging manifestations of cholangiocarcinomas are extremely diverse, since these tumors vary greatly in growth pattern and location," Dr. Sainani and colleagues write. "The accurate detection, characterization and assessment of the resectability of the tumor are the primary goals of imaging."