Comparison of flow patterns in ascending aortic aneurysms and volunteers using four‐dimensional magnetic resonance velocity mapping

Abstract

To determine the difference in flow patterns between healthy volunteers and ascending aortic aneurysm patients using time-resolved three-dimensional (3D) phase contrast magnetic resonance velocity (4D-flow) profiling. 4D-flow was performed on 19 healthy volunteers and 13 patients with ascending aortic aneurysms. Vector fields placed on 2D planes were visually graded to analyze helical and retrograde flow patterns along the aortic arch. Quantitative analysis of the pulsatile flow was carried out on manually segmented planes. In volunteers, flow progressed as follows: an initial jet of blood skewed toward the anterior right wall of the ascending aorta is reflected posterolaterally toward the inner curvature creating opposing helices, a right-handed helix along the left wall and a left-handed helix along the right wall; retrograde flow occurred in all volunteers along the inner curvature between the location of the two helices. In the aneurysm patients, the helices were larger; retrograde flow occurred earlier and lasted longer. The average velocity decreased between the ascending aorta and the transverse aorta in volunteers (47.9 mm/second decrease, P = 0.023), while in aneurysm patients the velocity increased (145 mm/second increase, P < 0.001). Dilation of the ascending aorta skews normal flow in the ascending aorta, changing retrograde and helical flow patterns.