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Assessment of Chronic Aortic Dissection: Contribution of Different ECG-Gated Breath-Hold MRI Techniques

R. Peter Kunz1, Katja Oberholzer1, Wlodzimierz Kuroczynski2, Georg Horstick3, Frank Krummenauer4, Manfred Thelen1 and Karl-Friedrich Kreitner1

1 Department of Radiology, Johannes Gutenberg-University, Langenbeckstrasse 1, Mainz 55131, Germany.
2 Department of Cardiothoracic and Vascular Surgery, Johannes Gutenberg-University, Mainz 55131, Germany.
3 Department of Internal Medicine and Cardiology, Johannes Gutenberg-University, Mainz 55131, Germany.
4 Department of Medical Biometry, Epidemiology and Informatics, Johannes Gutenberg-University, 55131 Mainz, Germany.



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  		Fig. 1A. ––59-year-old man with chronic Stanford type B dissection. Coronal contrast-enhanced MR angiography source image shows intimal flap in descending aorta and parietal thrombosis (star) of false channel.

 


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  		Fig. 1B. ––59-year-old man with chronic Stanford type B dissection. Maximum intensity projection of thoracic contrast-enhanced MR aortogram shows overview with normal ascending aorta and aortic arch and aneurysmal dilatation of dissected descending aorta.

 


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  		Fig. 1C. ––59-year-old man with chronic Stanford type B dissection. Multiplanar reformation of abdominal contrast-enhanced MR angiogram reveals that superior mesenteric artery arises from true lumen whereas celiac trunk (arrow).

 


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  		Fig. 2A. ––68-year-old man after graft repair of ascending aorta for Stanford type A dissection. Remote dissection with almost completely thrombosed false channel originates in second part of descending aorta and extends into abdominal aorta. Parasagittal HASTE image shows that intimal flap is masked by increased intraluminal signal in both lumina (stars). Findings were interpreted as parietal thrombosis because area of interest was not covered by axial black blood images. Note dilatation of aortic root with concomitant moderate aortic regurgitation.

 


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  		Fig. 2B. ––68-year-old man after graft repair of ascending aorta for Stanford type A dissection. Remote dissection with almost completely thrombosed false channel originates in second part of descending aorta and extends into abdominal aorta. Contrast-enhanced MR angiography source image depicts site of entry (arrow) at thoracoabdominal transition, retrograde propagation of dissection, and thrombosed portions of false channel.

 


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  		Fig. 3A. ––24-year-old woman after graft repair of ascending aorta and aortic valve resuspension for Stanford type A dissection. Oblique sagittal T1-weighted turbo spin-echo image shows residual intimal flap in descending aorta.

 


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  		Fig. 3B. ––24-year-old woman after graft repair of ascending aorta and aortic valve resuspension for Stanford type A dissection. Oblique sagittal T1-weighted turbo spin-echo image was obtained parallel to A.

 


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  		Fig. 3C. ––24-year-old woman after graft repair of ascending aorta and aortic valve resuspension for Stanford type A dissection. Contrast-enhanced MR angiography source image also depicts course and extent of persisting dissection membrane.

 


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  		Fig. 3D. ––24-year-old woman after graft repair of ascending aorta and aortic valve resuspension for Stanford type A dissection. Fast low-angle shot cine frame reveals aortic insufficiency. Hypointense diastolic jet (arrow) is directed against wall of left ventricular outflow tract. Regurgitant fraction determined by phase-contrast flow measurements was approximately 18%. Note residual intimal flap (star) in dilated aortic root, which is not visualized by black blood imaging in A or B.

 

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