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Aortic Aneurysm and Pseudoaneurysm Assessment

Maricela Contreras¹, Rajesh S. Amin¹, E. Kent Yucel¹

¹Brigham & Women's Hospital, Boston, Massachusetts

Publication Name:

Current Protocols in Magnetic Resonance Imaging

Unit Number:

Unit A12.2

DOI:

10.1002/0471142719.mia1202s03

Online Posting Date:

February, 2002

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Abstract

Although contrast angiography is still considered the “gold standard” for evaluation of the aorta and its major branches, Magnetic Resonance Angiography (MRA) has quickly gained popularity as an imaging tool for the assessment of the entire aorta. MRA serves as an alternative imaging modality that can be utilized in patients with impaired renal function and with allergies to iodinated contrast medium (iodinated contrast medium is required in contrast angiography and computed tomography, CT). The purpose of this unit is to present fundamental MRA techniques useful in the evaluation of the thoracic and abdominal aorta based on experience on a 1.5 T GE LX scanner.

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Unit Introduction
Basic Protocol 1: Imaging of Thoracic Aorta
Basic Protocol 2: Imaging of Abdominal Aorta
Alternate Protocol: Aneurysms Follow-Up
Commentary
Bibliography
Figures
Tables

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Materials

Basic Protocol 1: Imaging of Thoracic Aorta

Materials

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

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Figures

Figure A12.2.1

Pseudoaneurysm. Sagittal oblique maximum intensity projection (MIP) of the proximal aorta reveals a saccular pseudoaneurysm in the region of the isthmus.

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Figure A12.2.2

Ascending aortic aneurysm. Transverse double inversion recovery image demonstrates a 6 cm aneurysm in the ascending aorta at the level of the pulmonary artery. The etiology of this aneurysm was Takayasu's Arteritis.

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Figure A12.2.3

Penetrating ulcer. Coronal MIP image of a contrast-enhanced MRA (CEMRA) demonstrates a markedly tortuous thoracic aorta with a focal aneurysm in the aortic arch and a large penetrating ulcer in the proximal descending thoracic aorta. An infrarenal abdominal aortic aneurysm is also present.

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Figure A12.2.4

Abdominal aortic aneurysm with accessory right renal artery. Coronal MIP image of the abdominal aorta demonstrates an infrarenal aneurysm without extension into the common iliac arteries. A subtle small accessory right renal artery is also seen arising from the distal abdominal aorta.

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Figure A12.2.5

Coronal CEMRA of the distal aorta reveals a fusiform distal abdominal aortic aneurysm with extension into the common iliac arteries.

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Literature Cited

Literature Cited
	Crawford, E.S. and Hess, K.R. 1989. Abdominal aortic aneurysm. N. Engl. J. Med. 321:1040-1042.
	Grist, T. 2000. MRA of the abdominal aorta and lower extremities. J. Mag. Reson. Imaging 11:32-43.
	Hirose, Y., Hamada, S., Takamiya, M., Imakita, S., Naito, H., and Nishimura, T. 1992. Aortic aneurysm: Growth rates measured by CT. Radiology 185:249-252.
	Johnston, K.W., Rutherford, R.B., Tilson, M.D., Shah, D.M., Hollier, L., and Stanley, J.C. 1991. Suggested standards for reporting on aortic aneurysms. J. Vasc. Surg. 13:452-458.
	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.
	Schoenberg, S.O., Wunsch, C., Knopp, M.V., Essig, M., Hawighorst, H., Laub, G., Prince, M.R., Allenberg, J.R., and Van Kaick, G. 1999. Abdominal aortic aneurysm. Detection of multilevel vascular pathology by time-resolved multiphase 3D gadolinium MR angiography: Initial report. Invest. Radiol. 34:648-659.
	Shellock, F.G. 1996. Pocket Guide to MR Procedures and Metallic Objects. Lippincott-Raven, Philadelphia.
Key References
	Fenlon, H.M. and Yucel, E.K. 1999. Advances in abdominal, aortic, and peripheral contrast-enhanced MR angiography. In Magnetic Resonance Imaging Clinics of North America: New Techniques in Body MR Imaging. W. B. Sauders Company, Philadelphia.
Reviews basic principles and new MRA techniques in the evaluation of the aorta and peripheral arteries.
	Prince, M.R., Grist, T.M., and Debatin, J.K. 1999. 3D Contrast MR Angiography. 2nd Ed. Springer-Verlag, New York.
Provides practical information on the technical aspects and clinical applications of MR angiography.
	Yucel, E.K., Anderson, C.M., Edelman, R.R., Grist, T.M., Baum, R.A., Manning, W.J., Culebras, A., and Pearce, W. 1999. Magnetic resonance angiography: Update on applications for extracranial arteries (AHA Scientific Statement). Circulation 100:2284-2301.
The American Heart Association Science Advisory and Coordinating Committee reviews the current clinical applications and provides recommendations for the use of MRA in the extracranial vessels. Potential future clinical applications for MRA are also presented.