The Present and Future
JACC Review Topic of the Week
Discrepancies in Measurement of the Thoracic Aorta: JACC Review Topic of the Week

https://doi.org/10.1016/j.jacc.2020.03.084Get rights and content
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Highlights

  • Ascending aortic measurements are often discrepant between or within the modalities of CT, MRI, and echo.

  • Discrepancies arise from image formatting, diameter definition, irregular aortic contour, and inconsistent reporting patterns.

  • The impact of the following specific factors is explored:

    • Gated or nongated study? Contrast or no contrast study? Wall or no wall? Systole or diastole?

    • Hand measurement or automated centerline measurement?

    • Oblique or orthogonal? Smallest or largest diameter?

    • For the aortic root: sinus-to-commissure or sinus-to-sinus measurement?

Abstract

Clinicians often encounter discrepant measurements of the ascending aorta that impede, complicate, and impair appropriate clinical assessment—including key issues of presence or absence of aortic growth, rate of growth, and need for surgical intervention. These discrepancies may arise within a single modality (computed tomography scan, magnetic resonance imaging, or echocardiography) or between modalities. The authors explore the origins and significance of these discrepancies, revealing that some “truth” usually underlies all the discrepant measurements, which individually look at the ascending aorta with different perspectives and dimensional definitions. The authors conclude with a practical “question and answer” section that addresses common specific issues in interpretation and management of patients in the real-world setting.

Key Words

aortic root
ascending aorta
computed tomography
echocardiography
imaging discrepancies
thoracic aortic aneurysm

Abbreviations and Acronyms

CT
computed tomography
ECG
electrocardiogram
MRI
magnetic resonance imaging
TEE
transesophageal echocardiography
TTE
transthoracic echocardiography

Cited by (0)

Dr. Elefteriades is Principal of CoolSpine; serves on the Data and Safety Monitoring Board Member for Terumo; and is a consultant for CryoLife. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.

Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.