FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Volume 328:1-9 January 7, 1993 Number 1 Next

	Full Text Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods This study was designed to assess the safety and reliability of new noninvasive imaging methods as compared with aortography in the diagnosis of dissection of the thoracic aorta. One hundred ten patients with clinically suspected aortic dissection followed a diagnostic protocol that included transthoracic and transesophageal color-flow Doppler echocardiography (TTE and TEE), contrast-enhanced x-ray computed tomography (CT), and magnetic resonance imaging (MRI). Imaging results were compared in a blinded fashion and validated independently against intraoperative findings in 62 patients, autopsy findings in 7, and the results of contrast angiography in 64.

Results The sensitivities of MRI, TEE and x-ray CT for detecting dissection were similar, at 98.3, 97.7, and 93.8 percent, respectively; TTE had a sensitivity of only 59.3 percent (P<0.005). The specificities of both TTE (83.0 percent) and TEE (76.9 percent) were lower than those of x-ray CT (87.1 percent) and MRI (97.8 percent; P<0.05), mainly as a result of false positive findings in the ascending aorta. MRI and x-ray CT were more sensitive than TTE in detecting the formation of thrombus in the entire thoracic aorta (P<0.05), but were not superior to TEE in this regard. CT was not effective in detecting an entry site or aortic regurgitation, but MRI and TEE accurately identified both. Two patients died during or soon after CT and TEE, and three died between retrograde angiography and surgery.

Conclusions A noninvasive diagnostic strategy using MRI in all hemodynamically stable patients and TEE in patients who are too unstable to be moved should be considered the optimal approach to detecting dissection of the thoracic aorta. Comprehensive and detailed evaluation can thus be reduced to a single noninvasive diagnostic test in the investigation of suspected dissection of the thoracic aorta.

Source Information

From the Division of Cardiology, Department of Internal Medicine II (C.A.N., Y.v.K., V.S., C.B., D.H.K.), the Department of Diagnostic Radiology (V.N.), and the Department of Thoracic Surgery (A.P.), Universitats-Krankenhaus Eppendorf, Hamburg; and the Department of Radiology, Christian-Albrechts-Universitat, Kiel (R.P.S.) -- both in Germany.

Address reprint requests to Dr. Nienaber at the Department of Internal Medicine II, Division of Cardiology, Universitats-Krankenhaus Eppendorf, Martinistrasse 52, D-2000 Hamburg 20, Germany.

Full Text of this Article

Related Letters:

The Diagnosis of Thoracic Aortic Dissection by Noninvasive Imaging Procedures
Hartnell G., Costello P., Goldstein S. A., Lindsay J., Vasan R., Nienaber C. A., Spielmann R. P., Cigarroa J. E., Eagle K. A., Isselbacher E. M.
Extract | Full Text  
N Engl J Med 1993; 328:1637-1638, Jun 3, 1993. Correspondence

This article has been cited by other articles:

• Patel, P. D., Arora, R. R. (2008). Pathophysiology, diagnosis, and management of aortic dissection. Therapeutic Advances in Cardiovascular Disease 2: 439-468 [Abstract]  
• 2006 WRITING COMMITTEE MEMBERS, , Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S. (2008). 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation 118: e523-e661 [Full Text]  
• Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Nishimura, R. A., Carabello, B. A., Faxon, D. P., Freed, M. D., Lytle, B. W., O'Gara, P. T., O'Rourke, R. A., Shah, P. M. (2008). 2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 52: e1-e142 [Full Text]  
• Haydar, A. A, Morgan-Hughes, G., Roobottom, C. (2008). Investigating severe interscapular pain. BMJ 337: a688-a688 [Full Text]  
• Gleason, T. G., Bavaria, J. E. (2008). Trauma to the Great Vessels. Card Surg Adult 3: 1333-1354 [Full Text]  
• Kramer, C. M., Budoff, M. J., Fayad, Z. A., Ferrari, V. A., Goldman, C., Lesser, J. R., Martin, E. T., Rajagopalan, S., Reilly, J. P., Rodgers, G. P., Wechsler, L. (2007). ACCF/AHA 2007 Clinical Competence Statement on vascular imaging with computed tomography and magnetic resonance. Vasc Med 12: 359-378  
• Kramer, C. M., Budoff, M. J., Fayad, Z. A., Ferrari, V. A., Goldman, C., Lesser, J. R., Martin, E. T., Rajagopalan, S., Reilly, J. P., Rodgers, G. P., Wechsler, L., Creager, M. A., Holmes, D. R. Jr, Merli, G., Newby, L. K., Pina, I., Rodgers, G. P., Weitz, H. H. (2007). ACCF/AHA 2007 Clinical Competence Statement on Vascular Imaging With Computed Tomography and Magnetic Resonance: A Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training Developed in Collaboration With the Society of Atherosclerosis Imaging and Prevention, the Society for Cardiovascular Angiography and Interventions, the Society of Cardiovascular Computed Tomography, the Society for Cardiovascular Magnetic Resonance, and the Society for Vascular Medicine and Biology. J Am Coll Cardiol 50: 1097-1114 [Full Text]  
• Theodore, S., Vaidyanathan, K., Jagannath, B. R., Nainar, M., Krishnamoorthy, J., Cherian, K. M. (2007). Takayasu's Arteritis Mimicking Acute Aortic Dissection. Ann. Thorac. Surg. 83: 1876-1878 [Abstract] [Full Text]  
• Ince, H., Nienaber, C. A (2007). Diagnosis and management of patients with aortic dissection. Heart 93: 266-270 [Full Text]  
• Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Page, R. L., Riegel, B. (2006). ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 48: e1-e148 [Full Text]  
• Bonow, R. O., Carabello, B. A., Chatterjee, K., de Leon, A. C. Jr, Faxon, D. P., Freed, M. D., Gaasch, W. H., Lytle, B. W., Nishimura, R. A., O'Gara, P. T., O'Rourke, R. A., Otto, C. M., Shah, P. M., Shanewise, J. S., Smith, S. C. Jr, Jacobs, A. K., Adams, C. D., Anderson, J. L., Antman, E. M., Faxon, D. P., Fuster, V., Halperin, J. L., Hiratzka, L. F., Hunt, S. A., Lytle, B. W., Nishimura, R., Page, R. L., Riegel, B. (2006). ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 48: 598-675 [Full Text]  
• Shiga, T., Wajima, Z., Apfel, C. C., Inoue, T., Ohe, Y. (2006). Diagnostic Accuracy of Transesophageal Echocardiography, Helical Computed Tomography, and Magnetic Resonance Imaging for Suspected Thoracic Aortic Dissection: Systematic Review and Meta-analysis.. Arch Intern Med 166: 1350-1356 [Abstract] [Full Text]  
• Bitar, R., Moody, A. R., Leung, G., Kiss, A., Gladstone, D., Sahlas, D. J., Maggisano, R. (2006). In vivo identification of complicated upper thoracic aorta and arch vessel plaque by MR direct thrombus imaging in patients investigated for cerebrovascular disease.. Am. J. Roentgenol. 187: 228-234 [Abstract] [Full Text]  
• Ahmad, F, Cheshire, N, Hamady, M (2006). Acute aortic syndrome: pathology and therapeutic strategies.. Postgrad. Med. J. 82: 305-312 [Abstract] [Full Text]  
• Van Dantzig, J. M. (2006). Echocardiography in the Emergency Department. SEMIN CARDIOTHORAC VASC ANESTH 10: 79-81 [Abstract]  
• Flachskampf, F. A. (2006). Assessment of Aortic Dissection and Hematoma. SEMIN CARDIOTHORAC VASC ANESTH 10: 83-88 [Abstract]  
• Hayter, R. G., Rhea, J. T., Small, A., Tafazoli, F. S., Novelline, R. A. (2006). Suspected Aortic Dissection and Other Aortic Disorders: Multi-Detector Row CT in 373 Cases in the Emergency Setting. Radiology 238: 841-852 [Abstract] [Full Text]  
• Tilak, M., Smith, J., Rogers, D., Fox, P., Muntazar, M., Peyton, M. (2005). Successful near-term pregnancy outcome after repair of a dissecting thoracic aortic aneurysm at 14 weeks gestation: [Denouement heureux d'une grossesse menee presque a terme a la suite de la reparation d'un anevrysme dissequant de l'aorte thoracique a 14 semaines de gestation]. Canadian J. Anesthesia 52: 1071-1075 [Abstract] [Full Text]  
• Beaulieu, Y., Marik, P. E. (2005). Bedside Ultrasonography in the ICU: Part 2. Chest 128: 1766-1781 [Abstract] [Full Text]  
• Koschyk, D. H., Nienaber, C. A., Knap, M., Hofmann, T., Kodolitsch, Y. V., Skriabina, V., Ismail, M., Franzen, O., C. Rehders, T., Dieckmann, C., Lund, G., Reichenspurner, H., Meinertz, T. (2005). How to Guide Stent-Graft Implantation in Type B Aortic Dissection?: Comparison of Angiography, Transesophageal Echocardiography, and Intravascular Ultrasound. Circulation 112: I-260-I-264 [Abstract] [Full Text]  
• Beaver, T. M., Herrbold, F. N., Hess, P. J. Jr, Klodell, C. T., Martin, T. D. (2005). Transferring Diagnosis Versus Actual Diagnosis at a Center for Thoracic Aortic Disease. Ann. Thorac. Surg. 79: 1957-1960 [Abstract] [Full Text]  
• Evangelista, A., Mukherjee, D., Mehta, R. H., O'Gara, P. T., Fattori, R., Cooper, J. V., Smith, D. E., Oh, J. K., Hutchison, S., Sechtem, U., Isselbacher, E. M., Nienaber, C. A., Pape, L. A., Eagle, K. A., for the International Registry of Aortic Dissectio, (2005). Acute Intramural Hematoma of the Aorta: A Mystery in Evolution. Circulation 111: 1063-1070 [Abstract] [Full Text]  
• Pennell, D. J., Sechtem, U. P., Higgins, C. B., Manning, W. J., Pohost, G. M., Rademakers, F. E., van Rossum, A. C., Shaw, L. J., Yucel, E. K. (2004). Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report. Eur Heart J 25: 1940-1965 [Full Text]  
• Switzer, N. (2004). The Floating Viscera Sign. Radiology 232: 244-245 [Full Text]  
• Nienaber, C. A., Fattori, R., Mehta, R. H., Richartz, B. M., Evangelista, A., Petzsch, M., Cooper, J. V., Januzzi, J. L., Ince, H., Sechtem, U., Bossone, E., Fang, J., Smith, D. E., Isselbacher, E. M., Pape, L. A., Eagle, K. A., on Behalf of the International Registry of Acute A, (2004). Gender-Related Differences in Acute Aortic Dissection. Circulation 109: 3014-3021 [Abstract] [Full Text]  
• Olin, J. W., Kaufman, J. A., Bluemke, D. A., Bonow, R. O., Gerhard, M. D., Jaff, M. R., Rubin, G. D., Hall, W. (2004). Atherosclerotic Vascular Disease Conference: Writing Group IV: Imaging. Circulation 109: 2626-2633 [Full Text]  
• Sonker, U., Peek, D. F. P. M., van Der Meij, J. J. C., Heijmen, R. H., Seldenrijk, C. A., Knaepen, P. J. (2004). Primary lung tumor mimicking acute type A aortic dissection. Ann. Thorac. Surg. 77: 1841-1843 [Abstract] [Full Text]  
• Kunz, R. P., Oberholzer, K., Kuroczynski, W., Horstick, G., Krummenauer, F., Thelen, M., Kreitner, K.-F. (2004). Assessment of Chronic Aortic Dissection: Contribution of Different ECG-Gated Breath-Hold MRI Techniques. Am. J. Roentgenol. 182: 1319-1326 [Abstract] [Full Text]  
• Task Force members, , Maisch, B., Seferovic, P. M., Ristic, A. D., Erbel, R., Rienmuller, R., Adler, Y., Tomkowski, W. Z., Thiene, G., Yacoub, M. H., ESC Committee for Practice Guidelines, , Priori, S. G., Alonso Garcia, M. A., Blanc, J.-J., Budaj, A., Cowie, M., Dean, V., Deckers, J., Fernandez Burgos, E., Lekakis, J., Lindahl, B., Mazzotta, G., Moraies, J., Oto, A., Smiseth, O. A., Document Reviewers, , Mazzotta, G., Acar, J., Arbustini, E., Becker, A. E., Chiaranda, G., Hasin, Y., Jenni, R., Klein, W., Lang, I., Luscher, T. F., Pinto, F. J., Shabetai, R., Simoons, M. L., Soler Soler, J., Spodick, D. H. (2004). Guidelines on the Diagnosis and Management of Pericardial Diseases Executive Summary: The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. Eur Heart J 25: 587-610 [Full Text]  
• Vernhet, H., Serfaty, J. M., Serhal, M., McFadden, E., Bonnefoy, E., Adeleine, P., Revel, D., Douek, P. (2004). Abdominal CT Angiography Before Surgery as a Predictor of Postoperative Death in Acute Aortic Dissection. Am. J. Roentgenol. 182: 875-879 [Abstract] [Full Text]  
• Heatlie, G J, Pointon, K (2004). Cardiac magnetic resonance imaging. Postgrad. Med. J. 80: 19-22 [Abstract] [Full Text]  
• Olin, J. W., Fuster, V. (2003). Acute Aortic Dissection: The Need for Rapid, Accurate, and Readily Available Diagnostic Strategies. Arterioscler. Thromb. Vasc. Bio. 23: 1721-1723 [Full Text]  
• Shinohara, T., Suzuki, K., Okada, M., Shiigai, M., Shimizu, M., Maehara, T., Ohsuzu, F. (2003). Soluble Elastin Fragments in Serum Are Elevated in Acute Aortic Dissection. Arterioscler. Thromb. Vasc. Bio. 23: 1839-1844 [Abstract] [Full Text]  
• Kaji, S., Akasaka, T., Katayama, M., Yamamuro, A., Yamabe, K., Tamita, K., Akiyama, M., Watanabe, N., Tanemoto, K., Morioka, S., Yoshida, K. (2003). Prognosis of Retrograde Dissection From the Descending to the Ascending Aorta. Circulation 108: II-300-306 [Abstract] [Full Text]  
• Suzuki, T., Mehta, R. H., Ince, H., Nagai, R., Sakomura, Y., Weber, F., Sumiyoshi, T., Bossone, E., Trimarchi, S., Cooper, J. V., Smith, D. E., Isselbacher, E. M., Eagle, K. A., Nienaber, C. A. (2003). Clinical Profiles and Outcomes of Acute Type B Aortic Dissection in the Current Era: Lessons From the International Registry of Aortic Dissection (IRAD). Circulation 108: II-312-317 [Abstract] [Full Text]  
• Pohost, G. M., Hung, L., Doyle, M. (2003). Clinical Use of Cardiovascular Magnetic Resonance. Circulation 108: 647-653 [Full Text]  
• Nienaber, C. A., Eagle, K. A. (2003). Aortic Dissection: New Frontiers in Diagnosis and Management: Part II: Therapeutic Management and Follow-Up. Circulation 108: 772-778 [Full Text]  
• Nienaber, C. A., Eagle, K. A. (2003). Aortic Dissection: New Frontiers in Diagnosis and Management: Part I: From Etiology to Diagnostic Strategies. Circulation 108: 628-635 [Full Text]  
• Yoshida, S., Akiba, H., Tamakawa, M., Yama, N., Hareyama, M., Morishita, K., Abe, T. (2003). Thoracic Involvement of Type A Aortic Dissection and Intramural Hematoma: Diagnostic Accuracy--Comparison of Emergency Helical CT and Surgical Findings. Radiology 228: 430-435 [Abstract] [Full Text]  
• Wasir, H., Mehta, Y., Mishra, Y. K, Shrivastava, S., Mittal, S., Trehan, N. (2003). Transesophageal Echocardiography in Hypotensive Post-Coronary Bypass Patients. Asian Cardiovasc. Thorac. Ann. 11: 139-142 [Abstract] [Full Text]  
• Almassi, G. H. (2003). Proximal prolapse of aortic intimal flap: A rare complication of acute type A aortic dissection. J. Thorac. Cardiovasc. Surg. 125: 1546-1548 [Full Text]  
• Herkner, H. (2003). Challenge for emergency physicians. BMJ 326: 1134-1134 [Full Text]  
• Fox, J. A., Formanek, V., Friedrich, A., Shernan, S. K. (2003). Intraoperative Echocardiography. Card Surg Adult 2: 283-314 [Full Text]  
• Gleason, T. G., Bavaria, J. E. (2003). Trauma to Great Vessels. Card Surg Adult 2: 1229-1250 [Full Text]  
• Lissin, L. W., Vagelos, R. (2002). Acute aortic syndrome: a case presentation and review of the literature. Vasc Med 7: 281-287 [Abstract]  
• FROHOCK, F. M. (2002). Moving Lines and Variable Criteria: Differences/Connections between Allopathic and Alternative Medicine. The ANNALS of the American Academy of Political and Social Science 583: 214-232 [Abstract]  
• Khan, I. A., Nair, C. K. (2002). Clinical, Diagnostic, and Management Perspectives of Aortic Dissection*. Chest 122: 311-328 [Abstract] [Full Text]  
• Klompas, M. (2002). Does This Patient Have an Acute Thoracic Aortic Dissection?. JAMA 287: 2262-2272 [Abstract] [Full Text]  
• von Kodolitsch, Y., Aydin, M. A., Koschyk, D. H., Loose, R., Schalwat, I., Karck, M., Cremer, J., Haverich, A., Berger, J.u., Meinertz, T., Nienaber, C. A. (2002). Predictors of aneurysmal formation after surgical correction of aortic coarctation. J Am Coll Cardiol 39: 617-624 [Abstract] [Full Text]  
• Schoepf, U J, Becker, C R, Bruening, R D, Ohnesorge, B M, Huber, A, Haw, L-G, Hildebrandt, H, Reiser, M F (2001). Multislice CT angiography. Imaging 13: 357-365 [Abstract] [Full Text]  
• Riley, P, Rooney, S, Bonser, R, Guest, P (2001). Imaging the post-operative thoracic aorta: normal anatomy and pitfalls. Br. J. Radiol. 74: 1150-1158 [Abstract] [Full Text]  
• Sawhney, N. S., DeMaria, A. N., Blanchard, D. G. (2001). Aortic Intramural Hematoma : An Increasingly Recognized and Potentially Fatal Entity. Chest 120: 1340-1346 [Abstract] [Full Text]  
• Erbel, R., Alfonso, F., Boileau, C., Dirsch, O., Eber, B., Haverich, A., Rakowski, H., Struyven, J., Radegran, K., Sechtem, U., Taylor, J., Zollikofer, Ch., Klein, W.W., Mulder, B., Providencia, L.A. (2001). Diagnosis and management of aortic dissection: Task Force on Aortic Dissection, European Society of Cardiology. Eur Heart J 22: 1642-1681  
• Erbel, R. (2001). GENERAL CARDIOLOGY: Diseases of the thoracic aorta. Heart 86: 227-234 [Full Text]  
• Vignon, P., Spencer, K. T., Rambaud, G., Preux, P.-M., Krauss, D., Balasia, B., Lang, R. M. (2001). Differential Transesophageal Echocardiographic Diagnosis Between Linear Artifacts and Intraluminal Flap of Aortic Dissection or Disruption. Chest 119: 1778-1790 [Abstract] [Full Text]  
• Pennell, D. (2001). IMAGING TECHNIQUES: Cardiovascular magnetic resonance. Heart 85: 581-589 [Full Text]  
• Vaccari, G., Caciolli, S., Calamai, G., Acquafresca, M., Montesi, G., Braconi, L., Cassai, M., Perna, A. M. (2001). Intramural hematoma of the aorta: diagnosis and treatment. Eur. J. Cardiothorac. Surg. 19: 170-173 [Abstract] [Full Text]  
• Iwasaki, T., Iwasaki, T., Aihara, Y., Kanda, T., Oriuchi, N., Endo, K., Katoh, H., Suzuki, T., Nagai, R. (2001). Immunoscintigraphy of Aortic Dissection with 99mTc-Labeled Murine Anti-Smooth Muscle Myosin Monoclonal Antibody in Rats. JNM 42: 130-137 [Abstract] [Full Text]  
• von Kodolitsch, Y., Schwartz, A. G., Nienaber, C. A. (2000). Clinical Prediction of Acute Aortic Dissection. Arch Intern Med 160: 2977-2982 [Abstract] [Full Text]  
• Suzuki, T., Katoh, H., Tsuchio, Y., Hasegawa, A., Kurabayashi, M., Ohira, A., Hiramori, K., Sakomura, Y., Kasanuki, H., Hori, S., Aikawa, N., Abe, S., Tei, C., Nakagawa, Y., Nobuyoshi, M., Misu, K., Sumiyoshi, T., Nagai, R. (2000). Diagnostic Implications of Elevated Levels of Smooth-Muscle Myosin Heavy-Chain Protein in Acute Aortic Dissection: The Smooth Muscle Myosin Heavy Chain Study. ANN INTERN MED 133: 537-541 [Abstract] [Full Text]  
• Higgins, C. B. (2000). Cardiac Imaging. Radiology 217: 4-10 [Abstract] [Full Text]  
• Movsowitz, H. D., Levine, R. A., Hilgenberg, A. D., Isselbacher, E. M. (2000). Transesophageal echocardiographic description of the mechanisms of aortic regurgitation in acute type A aortic dissection: implications for aortic valve repair. J Am Coll Cardiol 36: 884-890 [Abstract] [Full Text]  
• Hug, J., Nagel, E., Bornstedt, A., Schnackenburg, B., Oswald, H., Fleck, E. (2000). Coronary Arterial Stents: Safety and Artifacts during MR Imaging. Radiology 216: 781-787 [Abstract] [Full Text]  
• MILLER, J. S, LEMAIRE, S. A, COSELLI, J. S (2000). Evaluating aortic dissection: when is coronary angiography indicated?. Heart 83: 615-616 [Full Text]  
• Hagan, P. G., Nienaber, C. A., Isselbacher, E. M., Bruckman, D., Karavite, D. J., Russman, P. L., Evangelista, A., Fattori, R., Suzuki, T., Oh, J. K., Moore, A. G., Malouf, J. F., Pape, L. A., Gaca, C., Sechtem, U., Lenferink, S., Deutsch, H. J., Diedrichs, H., Marcos y Robles, J., Llovet, A., Gilon, D., Das, S. K., Armstrong, W. F., Deeb, G. M., Eagle, K. A. (2000). The International Registry of Acute Aortic Dissection (IRAD): New Insights Into an Old Disease. JAMA 283: 897-903 [Abstract] [Full Text]  
• Willens, H. J., Kessler, K. M. (1999). Transesophageal Echocardiography in the Diagnosis of Diseases of the Thoracic Aorta* : Part 1. Aortic Dissection, Aortic Intramural Hematoma, and Penetrating Atherosclerotic Ulcer of the Aorta. Chest 116: 1772-1779 [Full Text]  
• Yucel, E. K., Anderson, C. M., Edelman, R. R., Grist, T. M., Baum, R. A., Manning, W. J., Culebras, A., Pearce, W. (1999). Magnetic Resonance Angiography : Update on Applications for Extracranial Arteries. Circulation 100: 2284-2301 [Full Text]  
• von Kodolitsch, Y., Simic, O., Schwartz, A., Dresler, C., Loose, R., Staudt, M., Ostermeyer, J., Haverich, A., Nienaber, C. A. (1999). Predictors of Proximal Aortic Dissection at the Time of Aortic Valve Replacement. Circulation 100: II-287-294 [Abstract] [Full Text]  
• Novelline, R. A., Rhea, J. T., Rao, P. M., Stuk, J. L. (1999). Helical CT in Emergency Radiology. Radiology 213: 321-339 [Abstract] [Full Text]  
• Kim, M. H., Eagle, K. A., Isselbacher, E. M. (1999). Bayesian Persuasion. Circulation 100 : e68-e72 [Full Text]  
• Fattori, R., Descovich, B., Bertaccini, P., Celletti, F., Caldarera, I., Pierangeli, A., Gavelli, G. (1999). Composite Graft Replacement of the Ascending Aorta: Leakage Detection with Gadolinium-enhanced MR Imaging. Radiology 212: 573-577 [Abstract] [Full Text]  
• Boxt, L. M. (1999). From the RSNA Refresher Courses: Cardiac MR Imaging: A Guide for the Beginner. RadioGraphics 19: 1009-1025 [Abstract] [Full Text]  
• Choudhry, N. K., Etchells, E. E. (1999). Does This Patient Have Aortic Regurgitation?. JAMA 281: 2231-2238 [Abstract] [Full Text]  
• Nienaber, C. A., Fattori, R., Lund, G., Dieckmann, C., Wolf, W., von Kodolitsch, Y., Nicolas, V., Pierangeli, A. (1999). Nonsurgical Reconstruction of Thoracic Aortic Dissection by Stent-Graft Placement. NEJM 340: 1539-1545 [Abstract] [Full Text]  
• Shapira, O. M., Aldea, G. S., Cutter, S. M., Fitzgerald, C. A., Lazar, A.N.P. H. L., Shemin, R. J. (1999). Improved clinical outcomes after operation of the proximal aorta: a 10-year experience. Ann. Thorac. Surg. 67: 1030-1037 [Abstract] [Full Text]  
• Svensson, L. G., Labib, S. B., Eisenhauer, A. C., Butterly, J. R. (1999). Intimal Tear Without Hematoma : An Important Variant of Aortic Dissection That Can Elude Current Imaging Techniques. Circulation 99: 1331-1336 [Abstract] [Full Text]  
• Gillinov, A. M., Lytle, B. W., Kaplon, R. J., Casselman, F. P., Blackstone, E. H., Cosgrove, D. M. (1999). DISSECTION OF THE ASCENDING AORTA AFTER PREVIOUS CARDIAC SURGERY: DIFFERENCES IN PRESENTATION AND MANAGEMENT. J. Thorac. Cardiovasc. Surg. 117: 252-260 [Abstract] [Full Text]  
• Kanojia, A., Kasliwal, R. R (1998). Recent Advances In Echocardiography of Aortic Disorders. Asian Cardiovasc. Thorac. Ann. 6: 153-157 [Abstract] [Full Text]  
• Olanow, C. W., Myllyla, V. V., Sotaniemi, K. A., Larsen, J. P., Palhagen, S., Przuntek, H., Heinonen, E. H., Kilkku, O., Lammintausta, R., Maki-Ikola, O., Rinne, U. K. (1998). Effect of selegiline on mortality in patients with Parkinson's disease: A meta-analysis. Neurology 51: 825-830 [Abstract] [Full Text]  
• Palhagen, S., Heinonen, E. H., Hagglund, J., Kaugesaar, T., Kontants, H., Maki-Ikola, O., Palm, R., Turunen, J., *Swedish Parkinson Study Group, (1998). Selegiline delays the onset of disability in de novo parkinsonian patients. Neurology 51: 520-525 [Abstract] [Full Text]  
• Yamamoto, M. (1998). Do dopamine agonists provide neuroprotection?. Neurology 51: S10-S12 [Abstract] [Full Text]  
• Poewe, W. (1998). Should treatment of Parkinson's disease be started with a dopamine agonist?. Neurology 51: S21-S24 [Abstract] [Full Text]  
• Heyman, A., Fillenbaum, G. G., Welsh-Bohmer, K. A., Gearing, M., Mirra, S. S., Mohs, R. C., Peterson, B. L., Pieper, C. F. (1998). Cerebral infarcts in patients with autopsy-proven Alzheimer's disease: CERAD, part XVIII. Neurology 51: 159-162 [Abstract] [Full Text]  
• Kaye, J. A. (1998). Diagnostic challenges in dementia. Neurology 51: S45-S52 [Abstract] [Full Text]  
• The Huntington Study Group*, (1998). Safety and tolerability of the free-radical scavenger OPC-14117 in Huntington's disease. Neurology 50: 1366-1373 [Abstract] [Full Text]  
• Chase, T. N. (1998). Levodopa therapy: Consequences of the nonphysiologic replacement of dopamine. Neurology 50: S17-S25 [Abstract] [Full Text]  
• Skoog, I., Wallin, A., Fredman, P., Hesse, C., Aevarsson, O., Karlsson, I., Gottfries, C. G., Blennow, K. (1998). A population study on blood-brain barrier function in 85-year-olds: Relation to Alzheimer's disease and vascular dementia. Neurology 50: 966-971 [Abstract] [Full Text]  
• Moriyama, Y., Yotsumoto, G., Kuriwaki, K., Watanabe, S., Hisatomi, K., Shimokawa, S., Toyohira, H., Taira, A. (1998). Intramural hematoma of the thoracic aorta. Eur. J. Cardiothorac. Surg. 13: 230-239 [Abstract] [Full Text]  
• The Dana Consortium on the Therapy of HIV Dementia, (1998). A randomized, double-blind, placebo-controlled trial of deprenyl and thioctic acid in human immunodeficiency virus-associated cognitive impairment. Neurology 50: 645-651 [Abstract] [Full Text]  
• (1998). Management of Parkinson's disease. Neurology 50: S2-S57 [Full Text]  
• Barthlen, G. M., Brown, L. K., Stacy, C. (1998). Polysomnographic documentation of seizures in a patient with obstructive sleep apnea syndrome. Neurology 50: 309-310 [Full Text]  
• Saku, K., Takeda, Y., Nii, T., Shirai, K., Okabe, M., Ohta, T., Arakawa, K., Saku, K. (1997). Three-Dimensional Spiral Computed Tomography Angiography as an Alternative Imaging Modality for a Silent Dissecting Aortic Aneurysm: A Case Report. ANGIOLOGY 48: 1067-1071 [Abstract]  
• Bennett, D. A., Shannon, K. M., Beckett, L. A., Goetz, C. G., Wilson, R. S. (1997). Metric properties of nurses' ratings of parkinsonian signs with a modified Unified Parkinson's Disease Rating Scale. Neurology 49: 1580-1587 [Abstract] [Full Text]  
• Patel, S., Alam, M., Rosman, H., Alam, M. (1997). Pitfalls in the Echocardiographic Diagnosis of Aortic Dissection. ANGIOLOGY 48: 939-946 [Abstract]  
• Harris, K. M., Braverman, A. C., Gutierrez, F. R., Barzilai, B., Davila-Roman, V. G. (1997). TRANSESOPHAGEAL ECHOCARDIOGRAPHIC AND CLINICAL FEATURES OF AORTIC INTRAMURAL HEMATOMA. J. Thorac. Cardiovasc. Surg. 114: 619-626 [Abstract] [Full Text]  
• Laperche, T., Laurian, C., Roudaut, R., Steg, P. G., de Cardiologie, f. t. F. E. d. l. S. F. (1997). Mobile Thromboses of the Aortic Arch Without Aortic Debris : A Transesophageal Echocardiographic Finding Associated With Unexplained Arterial Embolism. Circulation 96: 288-294 [Abstract] [Full Text]  
• Stern, M. B. (1997). Contemporary approaches to the pharmacotherapeutic management of Parkinson's disease: An overview. Neurology 49: S2-S9 [Abstract] [Full Text]