Dissection of the thoracic aorta: pre- and postoperative findings on turbo-FLASH MR images obtained in the plane of the aortic arch

MR Imaging of the Aorta

Recent advances in noninvasive imaging methods, such as CT and MR imaging, have replaced most of invasive angiographic procedures in the diagnosis of acquired aortic disease, decreasing the cost and morbidity of diagnosis. This article reviews and illustrates present MR imaging methods for evaluation of the aorta. Common diseases of the aorta also are discussed with a focus on their unique morphologic and functional features and characteristic MR imaging findings. Knowledge of pathologic conditions of common aortic diseases and proper MR imaging techniques enables accurate and time-efficient aortic evaluation.

Acquired diseases of the thoracic aorta: role of MRI and MRA

Diseases of the thoracic aorta can present with a broad clinical spectrum of symptoms and signs. Their prevalence appears to be increasing in western populations, most likely corresponding to aging and heightened clinical awareness but also influenced by the progress of high-resolution, noninvasive imaging modalities. Among them, MRI provides an excellent visualization of vascular structures and is well suited for evaluation of thoracic aorta disease. Currently, in many centers, noninvasive imaging modalities are the first choice in the cardiovascular system evaluation and diagnosis, reserving conventional angiography for use only before therapeutic intervention. Understanding the principle MRA techniques is essential for acquiring consistent diagnostic images. Basic technical considerations, which include fast spin-echo, fast gradient-echo, and MRA techniques with phase contrast and contrast-enhanced methods, are discussed and applied in the evaluation of acquired thoracic aorta diseases.

Long-term follow-up of 82 patients with chronic disease of the thoracic aorta using spin-echo and cine gradient magnetic resonance imaging

The objective of this study to examine the clinical impact of magnetic resonance imaging in long-term follow-up of patients (pts) with chronic disease of the thoracic aorta such as coarctation of the aorta, chronic aortic dissection and true aortic aneurysm. A total of 322 magnetic resonance examinations obtained in 82 pts with chronic disease of the thoracic aorta (31 pts with coarctation of the aorta (CoA), 29 pts with chronic aortic dissection and 22 pts with true aneurysm) over a period of 0.25 to 13.5 (mean +/- SD: 6.5 +/- 3.4) years were retrospectively reviewed. Diameters of the thoracic aorta were measured at predefined levels and morphological and functional parameters of special interest were analysed in each patient group. Pts were classified as having constant or progressive disease and clinical end-points were defined as (re-)operation or death. 43 pts (52%) (CoA 15 pts, chronic dissection 16 pts, true aneurysm 12 pts) had constant findings. None of them underwent (re-)operation and seven patients (16%) died, three of them from their aortic disease more than five years later after their last magnetic resonance examination, one from an arrhythmogenic event, and in the remaining 3 pts the cause of death could not be definitely established. 39 pts (48%) (CoA 16 pts, chronic dissection 13 pts, true aneurysm 10 pts) had progressive disease as demonstrated by repetitive magnetic resonance imaging. Of these 39 pts 24 pts underwent (re-)operation, in 15 pts operation was postponed. Four pts died from their aortic disease. Repetitive magnetic resonance imaging is a clinically feasible technique for long-term follow-up of pts with chronic disease of the thoracic aorta because it can detect progressive disease in a large subset of pts requiring elective surgery. The results of magnetic resonance imaging provided the rationale for either (re-)operation or conservative management, thus guiding patient management.

MRI of acute and chronic aortic pathology: pre-operative and postoperative evaluation

With recent advances in the understanding of aortic diseases, both power and versatility have put magnetic resonance imaging (MRI) in the focus of diagnostic work-up in the entire spectrum of clinical aortic pathology. Technical refinements, from classic anatomic imaging to three-dimensional gadolinium-enhanced MR angiography and tissue characterization, have rendered MRI ideal for assessment of acquired disease such as aortic dissection, intramural hematoma, and aneurysm, along with postoperative follow-up evaluation, with better reliability and safety than other imaging modalities. Moreover, congenital pathology of the aorta, including aortic arch anomalies and coarctation, can be non-invasively evaluated by MRI. With spectroscopy and the advent of high-resolution intravascular coils, MRI may even provide histopathologic and potentially prognostic information unparalleled by any other method. J. Magn. Reson. Imaging 1999;10:741-750.

Imaging of thoracic aortic disease

Computed tomography, magnetic resonance imaging, and transesophageal echocardiography represent the relatively noninvasive techniques available for imaging thoracic aortic disease, especially in the evaluation of aneurysms and dissections. The article discusses the technique and application of these modalities in the evaluation of thoracic aorta. Imaging appearances of the commonly encountered pathologies of the thoracic aorta are presented and discussed, and potential pitfalls of technique and diagnosis are addressed.