Circ Cardiovasc Imaging

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Presentation transcript:

Circ Cardiovasc Imaging Noninvasive Imaging Approaches to Evaluate the Patient With Known or Suspected Aortic Disease by Christoph A. Nienaber, Stephan Kische, Valeria Skriabina, and Hüseyin Ince Circ Cardiovasc Imaging Volume 2(6):499-506 November 17, 2009 Copyright © American Heart Association, Inc. All rights reserved.

Figure 1. Stanford type B aortic dissection on volume-rendered 64-slice multidetector CTA with compressed true lumen (TL) and expanded false lumen (FL). Figure 1. Stanford type B aortic dissection on volume-rendered 64-slice multidetector CTA with compressed true lumen (TL) and expanded false lumen (FL). Axial slices are displayed between 3D reconstruction from 2 views. The proximal entry to the dissection (black arrow) is adjacent to the offspring of a Lusorian artery (white arrow). Christoph A. Nienaber et al. Circ Cardiovasc Imaging. 2009;2:499-506 Copyright © American Heart Association, Inc. All rights reserved.

Figure 2. Three-dimensional reconstruction of a 64-slice multidetector CTA in a patient with severe coarctation, hypoplastic aortic arch, and ectasia of the ascending aorta. Figure 2. Three-dimensional reconstruction of a 64-slice multidetector CTA in a patient with severe coarctation, hypoplastic aortic arch, and ectasia of the ascending aorta. Note the detailed display of the collateral network resulting from high spatial resolution. Christoph A. Nienaber et al. Circ Cardiovasc Imaging. 2009;2:499-506 Copyright © American Heart Association, Inc. All rights reserved.

Figure 3. MRI based on spin-echo axial images in a patient with intramural hematoma of the thoracic aorta: The acute phase T1-weighted spin-echo image shows circular wall thickening of the ascending and descending aorta (A); subsequent T2-weighted image shows high signal intensity indicative of fresh intramural blood (B). Figure 3. MRI based on spin-echo axial images in a patient with intramural hematoma of the thoracic aorta: The acute phase T1-weighted spin-echo image shows circular wall thickening of the ascending and descending aorta (A); subsequent T2-weighted image shows high signal intensity indicative of fresh intramural blood (B). In subacute phase, formation of methemoglobin within the aortic wall is identified by high signal intensity in T1-weighted spin-echo sequences (C). Christoph A. Nienaber et al. Circ Cardiovasc Imaging. 2009;2:499-506 Copyright © American Heart Association, Inc. All rights reserved.

Figure 4. Contrast-enhanced MRA of chronic type B dissection originating from the aortic arch region in MIP (A) and as volume-rendered 3D reconstruction (B). Figure 4. Contrast-enhanced MRA of chronic type B dissection originating from the aortic arch region in MIP (A) and as volume-rendered 3D reconstruction (B). Follow-up MRA at 7 days after stent-graft placement shows a completely sealed proximal entry to the thrombosed false lumen. The diameter of the true lumen is normalized and the descending aorta is reconstructed (C). Christoph A. Nienaber et al. Circ Cardiovasc Imaging. 2009;2:499-506 Copyright © American Heart Association, Inc. All rights reserved.

Figure 5. TEE assessment of thoracic aortic disease: Acute type A dissection visualized in longitudinal and short-axis view; white arrows indicate dissection lamella (A) and an intimal tear in close proximity of the aortic leaflets (B). Figure 5. TEE assessment of thoracic aortic disease: Acute type A dissection visualized in longitudinal and short-axis view; white arrows indicate dissection lamella (A) and an intimal tear in close proximity of the aortic leaflets (B). Color flow mapping in a patient with chronic type B dissection shows vigorous flow into the false lumen (FL), demonstrating the communication between true and false lumen (C). Partial thrombosis in aneurysmatic FL in chronic type B dissection (D). Christoph A. Nienaber et al. Circ Cardiovasc Imaging. 2009;2:499-506 Copyright © American Heart Association, Inc. All rights reserved.

Figure 6. Takayasu arteritis: A, Coronal MIP 3D MRA shows significant stenosis of the right common carotid artery at its origin (small arrow). Figure 6. Takayasu arteritis: A, Coronal MIP 3D MRA shows significant stenosis of the right common carotid artery at its origin (small arrow). The left subclavian artery has 2 stenotic segments (large arrows) with a small area of poststenotic dilatation in between. There are also some luminal irregularities of the left common carotid artery. Axial unenhanced (C) and gadolinium-enhanced (B) T1-weighted MRIs show wall thickening of the ascending aorta (arrows). Christoph A. Nienaber et al. Circ Cardiovasc Imaging. 2009;2:499-506 Copyright © American Heart Association, Inc. All rights reserved.

Figure 7. Sixty-four–slice MDCT angiogram of a patient with para-anastomotic aneurysm (arrow) after previous open surgery (left). Figure 7. Sixty-four–slice MDCT angiogram of a patient with para-anastomotic aneurysm (arrow) after previous open surgery (left). The result after placement of a customized stent graft is shown in 2 views (right). Christoph A. Nienaber et al. Circ Cardiovasc Imaging. 2009;2:499-506 Copyright © American Heart Association, Inc. All rights reserved.

Figure 8. MRA-MIP images of an aortic arch aneurysm in parasagittal-oblique orientation (A). Figure 8. MRA-MIP images of an aortic arch aneurysm in parasagittal-oblique orientation (A). Follow-up study after a hybrid procedure with initial head vessel debranching and staged endovascular repair by use of a nitinol stent graft demonstrates perfect reconstruction of the proximal aorta in parasagittal-oblique projection (B) and axial reformatted orientation (C). Christoph A. Nienaber et al. Circ Cardiovasc Imaging. 2009;2:499-506 Copyright © American Heart Association, Inc. All rights reserved.