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[Magnetic resonance diagnosis of aortic dissection: with special reference to the communicating orifice between the
N Mukohara1, Y Yoshida, K Nakamura
1Second Department of Surgery, Kobe University School of Medicine.
Abstract:
Magnetic resonance imaging (MRI) was performed in thirty-one patients with aortic dissection to evaluate its usefulness in diagnosing the site of communicating orifice between the true and false lumens and the presence of retrograde dissection. MRI revealed the site of the entry as a defect in the intimal flap in the images of 12 of 15 patients (80%). The site of the communicating orifice between the true and false lumens in the abdominal aorta could be determined in six of eight patients (75%). MRI diagnosis of retrograde dissection was successful in three patients. Cross-sectional analysis of the abdominal aorta based on the location of the true lumen revealed that the celiac and superior mesenteric arteries tended to arise from the true lumen when the latter was situated in the anterior part of the abdominal aorta. The right and left renal arteries arose from the true lumen when it was positioned anterolaterally. In conclusion, MRI was a useful diagnostic method for aortic dissection, especially for determining the site of entry in the thoracic aorta. The changes in signal intensity in the false lumen provided useful information for locating the communicating orifice between the true and false lumens and for diagnosis of retrograde dissection. Cross-sectional analysis of dissection in the abdominal aorta was useful for predicting the branching of the main arteries from the true or false lumen.
Insights
Magnetic resonance imaging (MRI) is useful for diagnosing aortic dissection, identifying entry sites, and determining the location of communicating orifices between true and false lumens. This imaging technique aids in diagnosing retrograde dissection and predicting arterial branching in the abdominal aorta.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Medical Physics
Context:
- Aortic dissection is a life-threatening condition requiring accurate diagnosis.
- Conventional imaging modalities may have limitations in fully characterizing aortic dissection complexities.
- Magnetic resonance imaging (MRI) offers advanced visualization capabilities for cardiovascular structures.
Purpose:
- To evaluate the diagnostic utility of MRI in identifying the site of communicating orifices in aortic dissection.
- To assess MRI's effectiveness in diagnosing retrograde dissection.
- To analyze the relationship between true lumen position and major arterial origins in the abdominal aorta.
Summary:
- MRI successfully identified the entry site in 80% of patients with aortic dissection.
- The communicating orifice between true and false lumens in the abdominal aorta was determined in 75% of cases.
- MRI accurately diagnosed retrograde dissection in three patients and provided insights into arterial branching patterns based on true lumen location.
Impact:
- MRI serves as a valuable tool for diagnosing aortic dissection, particularly for pinpointing entry sites in the thoracic aorta.
- Signal intensity changes in the false lumen on MRI provide crucial information for locating communication points and diagnosing retrograde dissection.
- Cross-sectional MRI analysis of the abdominal aorta aids in predicting the origin of major arteries from either the true or false lumen, improving surgical planning.