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Entry tears of thoracic aortic dissections: MR appearance on gated SE imaging
1Department of Radiology, Seoul National University College of Medicine, Yongon-dong Chongno-gu, Seoul.
Objective:
The purpose of this study was to assess the ability of gated SE MR to demonstrate entry tears of thoracic aortic dissections and to elucidate their MR appearance.
Materials And Methods:
Gated SE MR images of nine consecutive patients with nonthrombosed aortic dissection on aortography were retrospectively analyzed.
Results:
Magnetic resonance consistently depicted an intimal flap and a double lumen in all nine patients. A focal intimal flap discontinuity suggesting an intimal tear was shown in eight patients. This intimal flap discontinuity was confirmed to be the entry tear by operation in five patients and by aortography in three. In five of eight patients with a focal intimal flap discontinuity, rapid influx of blood across an intimal defect produced a localized signal void area within the false lumen, which was surrounded by slow flow signal showing even-echo rephasing. This MR sign of a localized jet of flow void within the false lumen was very useful in determining the significance of a focal intimal flap discontinuity.
Conclusion:
Familiarity with these MR appearances of entry tears may enable their preoperative localization in a large proportion of aortic dissections on routine gated SE MRI.
Insights
Gated SE MRI effectively visualizes entry tears in thoracic aortic dissections, identifying intimal flap discontinuities. This technique aids in preoperative localization of these critical tears.
Area of Science:
- Cardiovascular Imaging
- Radiology
- Medical Diagnostics
Background:
- Thoracic aortic dissections are life-threatening conditions.
- Accurate identification of entry tears is crucial for surgical planning.
- Magnetic Resonance (MR) imaging offers non-invasive visualization capabilities.
Purpose of the Study:
- To evaluate the efficacy of gated Spin Echo (SE) MR in demonstrating entry tears of thoracic aortic dissections.
- To characterize the specific MR appearance of these entry tears.
Main Methods:
- Retrospective analysis of gated SE MR images from nine patients with nonthrombosed aortic dissection.
- Comparison of MR findings with aortography and surgical confirmation.
Main Results:
- Gated SE MR consistently identified intimal flaps and double lumens in all patients.
- Focal intimal flap discontinuities, suggestive of entry tears, were visualized in eight patients.
- A localized signal void within the false lumen, indicative of rapid blood influx, was observed in five patients, aiding in tear significance assessment.
Conclusions:
- Familiarity with these specific MR appearances can facilitate preoperative localization of entry tears in a significant proportion of aortic dissections.
- Routine gated SE MRI is a valuable tool for assessing thoracic aortic dissections.