Evaluation of Acute Aortic Dissection by Use with Gadolinium Enhanced MR Angiogra p hy: Comparison withSpin-echo MR Image

Kim, Jung Hoon; Kim, Hyae Young; Choi, Soo Jung; Choi, Seong Hoon; Lee, Jin Seong; Song, Koun Sik; Lim, Tae Hwan

Abstract

PURPOSE: To compare the usefulness of Gadolinium-enhanced MR angiography(Gd-MRA) with spin-echo(SE) MRI forthe evalvation of acute aortic dissection.
MATERIALS AND METHODS
During a recent one-year period weretrospectively reviewed the results of SE MRI and Gd-MRA in 14 patients (10 males, 4 females; mean age 57 years)with acute aortic dissection. DeBakey type I was found in six patients, DeBakey type II in one, and DeBakey typeIII in seven. MR techniques were as follows. First, multislice multiphase images were obtained in axial, coronaland oblique sagittal planes using SE T1WI(TR/TE/flip angle=600/14/90; acquisition time=25min), and images ofselected slices were obtained using breath-hold turbo SE T2WI(TR/TE/flip angle=800/76/160). Second, breath-holdGd-MRA imaging (3D-FISP; TR/TE/Flip angle=4.2/1.7/25; acquisition time=1min) was performed, with oblique sagittal(arch view) orientation. We compared 14 SE MRI images with nine thoracic and five abdominal Gd-MRA images,evalvating the presence and extent of intimal flap, entry and reentry tear, thrombus in false lumen (andcomparison to true lumen), the involvement of major branching vessels of the aortic arch, the origin of majorabdominal branching vessels, the presence of hemothorax and hemopericardium.
RESULTS
Both SE MRI and Gd-MRA veryaccurately detected the extent of intimal flap, and false lumen status. For detecting the site of entry tear, andthe involvement of major branching vessels at the aortic arch, Gd-MRA(n=12) was more accurate than SE MRI(n=7).When used to image 20 vessels in five patients, Gd-MRA identified with perfect accuracy the origin of majorabdominal branching vessels; SE MRI, however, demonstrated only six of 20 vessels. SE MRI, however, was muchsuperior for the identification of complications such as hemothorax(n=9) and hemopericardium(n=2); in thisrespect, Gd-MRA failed completely.
CONCLUSION
For the evaluation of patients with acute aortic dissection, Gd-MRAprovides information regarding site of entry tear and the involvement of major branching vessels very much fasterthan SE-MRI. In such cases, Gd-MRA can therefore be used for initial investigatory imaging.