Imaging modalities for the thoracic aorta

Almost 50 years after its introduction intra-arterial digital subtraction angiography (DSA) has been passed as the gold standard for diagnostic imaging of the aorta. Today's performance of multi-detector-row computed tomography angiography (CTA) as well as magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) offer remarkable improvements in the field of diagnostic cardiovascular imaging. The racy developments not only concerning image acquisition but also image postprocessing offer a multidimensional approach to assess anatomy and pathology of individual patients in a few minutes. Four-dimensional visualization assists us to select the "adequate" patient, quantify vascular and adjacent geometries, and select the appropriate device to realize even complex thoracic endovascular aortic reconstructions (TEVAR). There is still a discrepancy between perioperative and intraoperative imaging -but new technologies made also some progress in this field. Lifelong imaging surveillance of TEVAR and bypasses is still a critical component of patient care and requires comparable imaging and postprocessing capabilities as for the preoperative setting. Although is the most commonly used examination for imaging surveillance, MRA, chest x-ray and DSA all have their role in determining complications and their management.