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Aortic Dissection

Naoki Takahashi¹, Vamsidhar Narra¹

¹Mallinckrodt Institute of Radiology, Washington University Medical Center, St.Louis, Missouri

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A12.1

DOI:

10.1002/0471142719.mia1201s00

Online Posting Date:

May, 2001

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Abstract

This unit presents a Basic Protocol for imaging of thoracic aoprta to rule out aortic dissection. The core components of the imaging protocol are ECG (electrocardiograph)-gated black blood HASTE (half Fourier single shot turbo spin echo), and contrast-enhanced MR angiography (MRA). When no abnormal findings are seen in black blood HASTE or cine sequences, it is somewhat controversial whether contrast-enhanced MRA is necessary. An Alternate Protocol based on a time of flight (TOF) sequence is presented which can be used instead of contrast-enhanced MRA.

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Unit Introduction
Basic Protocol: Imaging of Thoracic Aorta to Rule Out Aortic Dissection
Alternate Protocol: Time of Flight (TOF)
Commentary
Literature Cited
Figures
Tables

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Materials

Basic Protocol: Imaging of Thoracic Aorta to Rule Out Aortic Dissection

Materials

Normal saline (0.9% NaCl), sterile
Gadolinium-based MR contrast agent (e.g., Magnevist, Omniscan, or Prohance)

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Figures

Figure A12.1.1

Aortic dissection. Transverse (A) and coronal (B) ECG-gated black blood images demonstrate an intimal flap (arrows) in the descending aorta. (C) Transverse ECG-gated TOF image demonstrates an intimal flap (arrow) in the descending aorta. (D) Multi-planar reconstruction image from the Gadolinium-enhanced MRA shows an intimal flap (arrow) in the descending aorta. The relation between the origin of left subclavian artery (arrowhead) and the flap is well depicted.

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Figure A12.1.2

Intramural hematoma. Transverse breath-hold ECG-gated T₁-weighted turbo spin echo image shows a crescent area of hyperintensity (arrows) in the wall of the descending aorta.

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Literature Cited

Literature Cited
	Krinsky, G.A., Rofsky, N.M., Decorato, D.R., Weinreb, J.C., Earls, J.P., Flyer, M.A., Galloway, A.C., and Colvin, S.B. 1997. Thoracic aorta: Comparison of gadolinium-enhanced three-dimensional MR angiography with conventional MR imaging. Radiology 202:183-193.
	Murray, J.G., Manisali, M., Flamm, S.D., Van Dyke, C.W., Lieber, M.L., Lytle, B.W., and White, R.D. 1997. Intramural hematoma of the thoracic aorta: MR image findings and their prognostic implications Radiology 204:349-355.
	Prince, M.R., Narasimham, D.L., Jacoby, W.T., Williams, D.M., Cho, K.J., Marx, M.V., and Deeb, G.M. 1996. Three-dimensional gadolinium-enhanced MR angiography of the thoracic aorta. AJR Am. J. Roentgenol. 166:1387-1389.
	Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
	Simonetti, O.P., Finn, J.P., White, R.D., Laub, G., and Henry, D.A. 1996. “Black blood” T₂-weighted inversion-recovery MR imaging of the heart. Radiology 1996:49-57.
	Sommer, T., Fehske, W., Holzknecht, N., Smekal, A.V., Keller, E., Lutterbey, G., Kreft, B., Kuhl, C., Gieseke, J., Abu-Ramadan, D., and Schild, H. 1996. Aortic dissection: a comparative study of diagnosis with spiral CT, multiplanar transesophageal echocardiography, and MR imaging. Radiology 199:347-352.