Simplified Rapid Protocol for Assessing the Thoracic Aortic Dimensions and Pathology with Noncontrast MR Angiography

Abstract

Contrast enhanced magnetic resonance angiography (CE-MRA) is limited by long acquisition time and contrast exposure in aortic emergencies. To compare the effcacy of dark blood (DB) and bright blood (BB) noncontrast sequences with the gold standard CE-MRA using a novel protocol for performing consistent thoracic aortic measurements and thoracic aortic pathologies identifications. A total of 66 patients with suspected or known thoracic aortic pathology who underwent CE-MRA underwent DB and BB imaging prior to CE-MRA for planning purposes. Aortic dimension was measured at 10 standard reference points in the ascending, arch, and descending aorta. Detection of aortic pathologies was recorded individually for each noncontrast sequence. When comparing the CE-MRA to the DB images and CE-MRA to the BB images, a majority of the measurement differences were less than or equal to 2 mm or resulted in no change of diagnostic class (95% for CE-MRA vs. DB and 96% for CE-MRA vs. BB). Of the patients who had major changes in diagnostic class (e.g., changes in two or three classes), the absolute measurements were not clinically significant in any given patient to warrant a change in management. Individually, the DB and BB sequences allowed for accurate recognition of all 47 aortic pathologies. DB and BB sequences produced comparable and consistent measurements of the thoracic aorta when compared with CE-MRA. In a situation where CE-MRA is not readily available or contraindicated, noncontrast MRA using our protocol is a reliable alternative to CE-MRA for assessment of aortic pathologies.

Keywords

noncontrast magnetic resonance angiography - dark blood - bright blood - thoracic aortic pathologies - thoracic aortic measurements - contrast-enhanced magnetic resonance angiography - thoracic aortic assessments

^* Both authors contributed equally to manuscript.

• References

• 1 Hiratzka LF, Bakris GL, Beckman JA. , et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American College of Radiology; American Stroke Association; Society of Cardiovascular Anesthesiologists; Society for Cardiovascular Angiography and Interventions; Society of Interventional Radiology; Society of Thoracic Surgeons; Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010; 121 (13) e266-e369
• 2 Othersen JB, Maize JC, Woolson RF, Budisavljevic MN. Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant 2007; 22 (11) 3179-3185
• 3 Broome DR, Girguis MS, Baron PW, Cottrell AC, Kjellin I, Kirk GA. Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned. AJR Am J Roentgenol 2007; 188 (02) 586-592
• 4 Gebker R, Gomaa O, Schnackenburg B, Rebakowski J, Fleck E, Nagel E. Comparison of different MRI techniques for the assessment of thoracic aortic pathology: 3D contrast enhanced MR angiography, turbo spin echo and balanced steady state free precession. Int J Cardiovasc Imaging 2007; 23 (06) 747-756
• 5 Moore AG, Eagle KA, Bruckman D. , et al. Choice of computed tomography, transesophageal echocardiography, magnetic resonance imaging, and aortography in acute aortic dissection: International Registry of Acute Aortic Dissection (IRAD). Am J Cardiol 2002; 89 (10) 1235-1238
• 6 François CJ, Tuite D, Deshpande V, Jerecic R, Weale P, Carr JC. Unenhanced MR angiography of the thoracic aorta: initial clinical evaluation. AJR Am J Roentgenol 2008; 190 (04) 902-906
• 7 Chalard F, Ferey S, Teinturier C, Kalifa G. Aortic dilatation in Turner syndrome: the role of MRI in early recognition. Pediatr Radiol 2005; 35 (03) 323-326
• 8 Krishnam MS, Tomasian A, Malik S, Desphande V, Laub G, Ruehm SG. Image quality and diagnostic accuracy of unenhanced SSFP MR angiography compared with conventional contrast-enhanced MR angiography for the assessment of thoracic aortic diseases. Eur Radiol 2010; 20 (06) 1311-1320
• 9 von Knobelsdorff-Brenkenhoff F, Gruettner H, Trauzeddel RF, Greiser A, Schulz-Menger J. Comparison of native high-resolution 3D and contrast-enhanced MR angiography for assessing the thoracic aorta. Eur Heart J Cardiovasc Imaging 2014; 15 (06) 651-658
• 10 Srichai MB, Kim S, Axel L, Babb J, Hecht EM. Non-gadolinium-enhanced 3-dimensional magnetic resonance angiography for the evaluation of thoracic aortic disease: a preliminary experience. Tex Heart Inst J 2010; 37 (01) 58-65
• 11 Urata J, Miyazaki M, Wada H, Nakaura T, Yamashita Y, Takahashi M. Clinical evaluation of aortic diseases using nonenhanced MRA with ECG-triggered 3D half-Fourier FSE. J Magn Reson Imaging 2001; 14 (02) 113-119
• 12 Prince MR, Narasimham DL, Jacoby WT. , et al. Three-dimensional gadolinium-enhanced MR angiography of the thoracic aorta. AJR Am J Roentgenol 1996; 166 (06) 1387-1397
• 13 Di Cesare E, Giordano AV, Cerone G, De Remigis F, Deusanio G, Masciocchi C. Comparative evaluation of TEE, conventional MRI and contrast-enhanced 3D breath-hold MRA in the post-operative follow-up of dissecting aneurysms. Int J Card Imaging 2000; 16 (03) 135-147