From the Guidelines
Ultrasound is a reliable and effective tool for confirming aortic atherosclerosis, particularly in the abdominal aorta, with high sensitivity and specificity approaching 100%. The procedure is non-invasive, radiation-free, and relatively inexpensive, making it a good initial screening tool [ 1 ]. Abdominal ultrasound can detect atherosclerotic plaque, wall thickening, and calcifications in the abdominal aorta. However, it has limitations in visualizing the thoracic aorta due to interference from lung tissue and bones. For thoracic aortic assessment, other imaging modalities like CT angiography or MRI may be more appropriate.
Key Points to Consider
- Ultrasound is the mainstay imaging procedure for abdominal aortic aneurysm (AAA) screening and surveillance [ 1 ].
- The American Institute of Ultrasound in Medicine recommends measuring the greatest diameter of the abdominal aorta from the outer-to-outer (OTO) edges of the aortic wall [ 1 ].
- Ultrasound accuracy depends on the operator's skill and patient factors such as body habitus [ 1 ].
- Pre-evaluation overnight fasting is recommended to reduce bowel gas in patients [ 1 ].
- For comprehensive evaluation of severe disease or for surgical planning, more advanced imaging like CT angiography or MRI may be needed [ 1 ].
Limitations and Alternatives
- Ultrasound has limitations in visualizing the thoracic aorta due to interference from lung tissue and bones [ 1 ].
- CT provides superior visualization of the abdominal aorta and its branches and is an excellent alternative when ultrasound is inadequate [ 1 ].
- MRI is a reasonable alternative to CT, especially for patients who cannot-dessert with IV contrast [ 1 ].
From the Research
Ultrasound and Aortic Atherosclerosis
- Ultrasound can be used to detect atherosclerosis in the aorta, as mentioned in 2, which discusses the use of epiaortic ultrasound and transesophageal echocardiography for diagnosing thoracic aortic disease.
- However, the provided studies do not directly confirm that ultrasound can be used to confirm aortic atherosclerosis, but rather suggest that other imaging modalities such as computed tomography and magnetic resonance imaging are more commonly used for this purpose, as seen in 3, 4, and 5.
- The study in 6 discusses dynamic imaging of aortic pathologies, including the use of ultrasound, but does not specifically address the confirmation of aortic atherosclerosis using ultrasound.
Imaging Modalities for Aortic Atherosclerosis
- Computed tomography is used to detect atherosclerotic lesions in the abdominal aorta, as seen in 3.
- Magnetic resonance imaging is used to visualize and quantify atherosclerotic plaque in the abdominal and thoracic aorta, as mentioned in 5.
- Ultrasound is mentioned as a potential imaging modality for detecting atherosclerosis in the aorta, but its use is not as prominent as other modalities in the provided studies.
Clinical Applications and Limitations
- The study in 4 provides an overview of coronary and non-coronary atherosclerosis and summarizes the current understanding of different available imaging techniques.
- The review in 2 argues for routine ultrasound screening of the thoracic aorta in the cardiac surgery population to improve postoperative outcomes.
- The study in 6 discusses the clinical applications and limitations of dynamic imaging techniques for aortic pathologies, including ultrasound.