Time-Resolved Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography in Patients with Chronic Expanding and Stable Aortic Dissections.

Michael Trojan,Matthias Müller-Eschner,Dittmar Böckler,Hendrik Von Tengg-Kobligk,Fabian Rengier,Hans-Ulrich Kauczor,Drosos Kotelis,Sasan Partovi,Christian Fink,Christof Karmonik

doi:10.1155/2017/5428914

Abstract

Objective To prospectively evaluate our hypothesis that three-dimensional time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA) is able to detect hemodynamic alterations in patients with chronic expanding aortic dissection compared to stable aortic dissections. Materials and Methods 20 patients with chronic or residual aortic dissection in the descending aorta and patent false lumen underwent TR-MRA of the aorta at 1.5 T and repeated follow-up imaging (mean follow-up 5.4 years). 7 patients showed chronic aortic expansion and 13 patients had stable aortic diameters. Regions of interest were placed in the nondissected ascending aorta and the false lumen of the descending aorta at the level of the diaphragm (FL-diaphragm level) resulting in respective time-intensity curves. Results For the FL-diaphragm level, time-to-peak intensity and full width at half maximum were significantly shorter in the expansion group compared to the stable group (p = 0.027 and p = 0.003), and upward and downward slopes of time-intensity curves were significantly steeper (p = 0.015 and p = 0.005). The delay of peak intensity in the FL-diaphragm level compared to the nondissected ascending aorta was significantly shorter in the expansion group compared to the stable group (p = 0.01). Conclusions 3D TR-MRA detects significant alterations of hemodynamics within the patent false lumen of chronic expanding aortic dissections compared to stable aortic dissections.

Highlights

Chronic expansion of aortic dissection is a frequent complication in patients with aortic dissection [1,2,3]
To prospectively evaluate our hypothesis that three-dimensional time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA) is able to detect hemodynamic alterations in patients with chronic expanding aortic dissection compared to stable aortic dissections
3D TR-MRA detects significant alterations of hemodynamics within the patent false lumen of chronic expanding aortic dissections compared to stable aortic dissections

Summary

Introduction

Chronic expansion of aortic dissection is a frequent complication in patients with aortic dissection [1,2,3]. Increasing aortic diameters carry the risk of aortic rupture as a potentially fatal event [4]. Patients with aortic dissection require lifelong imaging follow-up to detect potential aortic expansion which can be treated by endovascular repair or surgical procedures [5, 6]. Up to date, imaging intervals are standardized for all patients with aortic dissection usually without considering individual risk factors for aortic expansion. It would be desirable to estimate the individual risk for aortic expansion to determine the individually optimal imaging interval, to depict the time point of intervention if necessary, and to prevent potentially fatal aortic rupture

Methods

Results

Conclusion