Detection and Hemodynamic Evaluation of Flap Fenestrations in Type B Aortic Dissection with 4D Flow MRI: Comparison with Conventional MRI and CTA.

Abstract

The purpose of this study was to compare dissection flap fenestration visualization between 4D flow MRI, clinical MRI/MRA, and clinical CTA studies and describe the presence of hemodynamically active fenestration flow using 4D flow. Nineteen patients with type B dissection (age: 57±5 years) who had undergone standard of-care MRI/MRA of the chest including 4D flow MRI were retrospectively identified. Fourteen of the 19 patients also had CTA performed within 2 years of the MRI/MRA study with no interval surgery. Image review was performed independently by two radiologists. The number of fenestrations (including entry and exit tears), location, and flow directionality were recorded. Differences in the rate of detection between techniques was assessed using a Wilcoxon signed rank test. 4D flow detected more fenestrations relative to MRI/MRA [rev 1: +3 (10%), rev 2: +5 (20%)]. There were similar numbers of fenestrations detected by 4D flow relative to CTA [rev 1: +1 (4%), rev 2: -3 (-12%)]. MRI/MRA detected fewer fenestration relative to CTA in this cohort [rev 1: -6 (-24%), rev 2: -5 (-19%)]. No differences were significant. Combining 4D flow and MRI/MRA resulted in additional fenestration detection. Most fenestrations demonstrated biphasic flow over the cardiac cycle (flow entering false lumen in systole and exiting during diastole, rev 1:18/33, rev 2: 16/30). 4D flow MRI can detect small flap fenestration in type B dissection patients while providing additional information about flow through fenestrations throughout the cardiac cycle relative to CTA and conventional MRI.