Work

CT-Centered Multimodality Imaging of Arterial Wall Fragility in Acute Aortic Syndromes: A Narrative Review of Imaging Markers and Clinical Implications

Year: 2026

Type: review

Abstract: Arterial wall fragility represents a unifying pathophysiological substrate underlying a broad spectrum of aortic diseases, including aneurysms, dissections, intramural hematoma, penetrating atherosclerotic ulcers, and aortitis. Rather than distinct entities, these conditions increasingly appear as interconnected manifestations of impaired wall integrity and maladaptive vascular remodeling. This narrative review provides a structured overview of the imaging correlates of arterial wall fragility from a CT-centered, multimodality perspective. Computed Tomography Angiography (CTA) remains the first-line imaging modality in acute settings, enabling rapid and comprehensive assessment of vascular anatomy, luminal integrity, and the presence of life-threatening complications. Complementary modalities, including magnetic resonance imaging and ultrasound, contribute additional information on tissue characterization and hemodynamic evaluation in selected stable patients, follow-up settings, or specific clinical scenarios. Across imaging modalities, specific features-such as false lumen patency, intramural hematoma characteristics, ulcer-like projections, aneurysm morphology, and periaortic inflammatory changes-have been reported as markers of wall instability. These imaging-derived findings may provide clinically relevant information beyond traditional diameter-based assessment and support more refined risk stratification. Emerging approaches, including artificial intelligence, radiomics, computational modeling, and advanced MRI techniques, are expanding the role of imaging toward quantitative evaluation. However, their routine clinical implementation still requires standardization and prospective validation. Overall, a CT-centered multimodality imaging strategy may support a more comprehensive assessment of arterial wall fragility and contribute to individualized clinical decision-making in patients with aortic disease.

Source: Journal of Cardiovascular Development and Disease

DOI: 10.3390/jcdd13060221

Authors: Manuela Montatore, Ruggiero Tupputi, Federica Masino, Michela Montatore, Eluisa Muscogiuri, Giuseppe Guglielmi

Institutions: University of Foggia, Polytechnic University of Bari, Ospedale A. Perrino

Language: English

Topic: Aortic Disease and Treatment Approaches

Subfield: Pulmonary and Respiratory Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $3,258