Morphology and hemodynamics in dissection of the descending aorta. Assessment with MR imaging

To obtain morphologic and functional information in patients with dissection of the descending aorta using contrast-enhanced MR angiography (MRA) and MR blood flow quantification of the true and false lumina.

Fourteen patients were studied prospectively using a 1.5 T unit. MRA was performed with a 3D FISP sequence (TR/TE/flip angle 4.7/1.9 ms/30 degrees) after injection of 0.2 mmol Gd-DTPA per kg b.w. Flow quantification with phase velocity mapping was done at the level of the diaphragm using a 2D FLASH technique (TR/TE/flip angle 28/6.5 ms/30 degrees) with an average temporal resolution of 23 frames per cardiac cycle (34 ms). A spectral broadening index was applied to quantify the amount of flow irregularity within both channels of the aorta. Extension of the dissection and involvement of the major branch vessels were analyzed.

The mean flow volume per minute was 1,982 ml (SD 1,083 ml) in the true and 1,052 ml (SD 763 ml) in the false lumen. Average peak-velocities were 98 cm/s (SD 33 cm/s) in the true channel and 47 cm/s (SD 26 cm/s) in the false channel. Ten patients had bidirectional flow in the false lumen with a reflux volume ranging between 6.8% and 98%. Only 1 patient presented with bidirectional flow in the true lumen (reflux volume 15%). A significantly higher degree of flow irregularity was found in the false lumen compared with the true channel.

Different hemodynamic patterns were found in aortic dissection. Their prognostic value and the impact on therapy, specifically percutaneous interventional procedures, have to be further studied.