Current Imaging Strategies in Patients with Abdominal Aortic Aneurysms

Abstract

Background An abdominal aortic aneurysm (AAA) is defined as a localized dilatation of the abdominal aorta of ≥ 3 cm. With a prevalence of 4–8 %, AAA is one of the most common vascular diseases in Western society. Radiological imaging is an elementary component in the diagnosis, monitoring, and treatment planning of AAA patients.

Method This is a narrative review article on preoperative imaging strategies of AAA, incorporating expert opinions based on the current literature and standard-of-care practices from our own center. Examples are provided to illustrate clinical cases from our institution.

Results and Conclusion Radiological imaging plays a pivotal role in the initial diagnosis and monitoring of patients with AAA. Ultrasound is the mainstay imaging modality for AAA screening and surveillance. Contrast-enhanced CT angiography is currently considered the gold standard for preoperative imaging and image-based treatment planning in AAA repair. New non-contrast MR angiography techniques are robustly applicable and allow precise determination of aortic diameters, which is of critical importance, particularly with regard to current diameter-based surgical treatment guidelines. 3D imaging with multiplanar reformation and automatic centerline positioning enables more accurate assessment of the maximum aortic diameter. Modern imaging techniques such as 4D flow MRI have the potential to further improve individualized risk stratification in patients with AAA.

Key points: 

• Ultrasound is the mainstay imaging modality for AAA screening and monitoring

• Contrast-enhanced CT angiography is the gold standard for preoperative imaging in AAA repair

• Non-contrast MR angiography allows for accurate monitoring of aortic diameters in AAA patients

• Measurement of aortic diameters is more accurate with 3D-CT/MRI compared to ultrasound

• Research seeks new quantitative imaging biomarkers for AAA risk stratification, e. g., using 4D flow MRI

Zusammenfassung

Hintergrund Das abdominelle Aortenaneurysma (AAA) ist definiert als eine lokale Erweiterung der abdominellen Aorta auf ≥ 3 cm. Mit einer Prävalenz von 4–8 % ist das AAA eine der häufigsten Gefäßerkrankungen in der westlichen Gesellschaft. Die radiologische Bildgebung ist ein elementarer Bestandteil sowohl in der Diagnosestellung als auch der Überwachung und operativen Planung von Patienten mit Bauchaortenaneurysma.

Methode Dies ist ein narrativer Übersichtsartikel zu präoperativen Bildgebungsstrategien beim AAA, der Expertenmeinungen auf der Grundlage der aktuellen Literatur und Standardverfahren aus unserem eigenen Zentrum berücksichtigt. Anhand von Beispielen werden klinische Fälle aus unserer Einrichtung illustriert.

Ergebnisse und Schlussfolgerungen Die radiologische Bildgebung spielt eine zentrale Rolle bei der Erstdiagnose und Überwachung von Patienten mit AAA. Ultraschall ist das wichtigste bildgebende Verfahren für das Screening und die Überwachung des AAA. Die kontrastmittelverstärkte CT-Angiographie ist derzeit der Goldstandard für die präoperative Bildgebung und bildbasierte Behandlungsplanung. Neue kontrastfreie MR-Angiografietechniken sind robust einsetzbar und ermöglichen eine präzise Bestimmung des Aortendurchmessers, der insbesondere im Hinblick auf die hierauf basierenden chirurgischen Therapierichtlinien von entscheidender Bedeutung ist. Die 3D-CT- oder MRT-Bildgebung mittels multiplanarer Reformation und automatischer Centerline-Positionierung erlaubt eine präzisere Messung des maximalen Aortendurchmessers. Moderne bildgebende Verfahren wie die 4D-Fluss-MRT haben das Potenzial, die individualisierte Risikostratifizierung bei Patienten mit AAA weiter zu verbessern.

Kernaussagen: 

• Ultraschall ist das wichtigste bildgebende Verfahren für das AAA-Screening und die Überwachung

• Die kontrastverstärkte CT-Angiographie gilt derzeit als Goldstandard zur präoperativen Bildgebung bei der AAA-Reparatur

• Die kontrastmittelfreie MR-Angiographie ermöglicht eine genaue Überwachung des Aortendurchmessers bei AAA-Patienten

• 3D-CT- oder MR-Bildgebung mit multiplanarer Reformation ermöglicht im Vergleich zum Ultraschall eine genauere Bestimmung des maximalen Aortendurchmessers

• Die Forschung sucht nach neuen quantitativen Biomarkern für die AAA-Risikostratifizierung, z. B. mit Hilfe der 4D-Fluss-MRT

Zitierweise

• Ristow I, Riedel C, Lenz A et al. Current Imaging Strategies in Patients with Abdominal Aortic Aneurysms. Fortschr Röntgenstr 2024; 196: 52 – 61

Key words

abdominal aortic aneurysm - intraluminal thrombus - angiography - growth prediction - diameter

Publication History

Received: 01 March 2023

Accepted: 14 June 2023

Article published online:
12 September 2023

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