From the Guidelines
A CT chest scan to monitor an ascending aortic aneurysm does not always require contrast, and the choice of imaging modality and use of contrast should be individualized based on the patient's specific clinical scenario and factors such as kidney function and history of contrast allergies. When monitoring an ascending aortic aneurysm, the primary goal is to accurately measure the size of the aorta and track aneurysm growth over time, while minimizing radiation exposure and potential complications. According to the 2024 ESC guidelines for the management of peripheral arterial and aortic diseases 1, the best imaging modality depends on aneurysm location, and for the ascending aorta, TTE, CCT, or CMR can be used. For initial diagnosis and comprehensive evaluation, contrast-enhanced CT scans are typically recommended, as they provide better visualization of the vessel wall, potential leaks, and involvement of branch vessels. However, for routine follow-up monitoring of a stable aneurysm, non-contrast CT scans or alternative imaging modalities such as MRI may be adequate, especially in patients with impaired kidney function or history of contrast allergies. The frequency of monitoring depends on the aneurysm size, with larger aneurysms typically requiring more frequent imaging, usually every 6-12 months, as recommended by the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. Key factors to consider when choosing an imaging modality and deciding on the use of contrast include:
- Aneurysm size and location
- Patient's kidney function and history of contrast allergies
- Specific clinical question being addressed
- Need for comprehensive evaluation versus routine follow-up monitoring
- Potential risks and benefits of contrast-enhanced imaging.
From the Research
Monitoring Ascending Aortic Aneurysm
- The use of imaging techniques such as computed tomography (CT) angiography and magnetic resonance angiography is crucial in the diagnosis and management of ascending aortic aneurysms 2.
- Echocardiography is also an essential tool for evaluating aortic aneurysms, assessing different etiologies, and associated complications, as well as for serial follow-up 3.
- Cardiac CT angiography is an excellent imaging modality for diagnosing and confirming ascending aortic aneurysms, allowing for simultaneous analysis of the coronary artery tree 4.
Importance of Contracts for Monitoring
- There is no direct evidence to suggest that a CT chest is required to have contracts to monitor ascending aortic aneurysm.
- However, studies emphasize the importance of regular follow-up and monitoring of patients with ascending aortic aneurysms to prevent complications such as dissection or rupture 5, 6.
- The role of imaging in diagnosis and surgical management of ascending aortic aneurysms is well-established, and contracts may be necessary to ensure timely and appropriate monitoring and treatment 2.