MRI is the imaging modality of choice in the assessment of longstanding aortic disease in a patient who has chronicchest pain who is hemodynamically stable or for the evaluation of a chronic dissection.
An MRI examination of the aorta will produce a three-dimensional reconstruction of the aorta, allowing the physician to determine the location of the intimal tear, the involvement of branch vessels, and locate any secondary tears.
The disadvantage of the MRI scan in the face of aortic dissection is that it has limited availability and is often located only in larger hospitals, and the scan is relatively time-consuming.
Due to the high intensity of the magnetic waves used during MRI, an MRI scan is contraindicated in individuals with metallic implants.
In addition, many individuals develop claustrophobia while in the MRI scanning tube.
2022 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease[2]
Recommendations for HTAD: Genetic Testing and Screening of Family Members for TAD Referenced studies that support the recommendations are summarized in the Online Data Supplement
1. In patients with TAD who have a pathogenic/likely pathogenic variant, genetic testing of at-risk biological relatives (ie, cascade testing) is recommended.6,10,11 In family members who are found by genetic screening to have inherited the pathogenic/likely pathogenic variant, aortic imaging with TTE (if aortic root and ascending aorta are adequately visualized, otherwise with CT or MRI) is recommended.(Level of Evidence: B-NR)
Recommendations for Aortic Imaging Techniques to Determine Presence and Progression of Aortic Disease Referenced studies that support the recommendations are summarized in the Online Data Supplement
1. In patients with known or suspected aortic disease, when performing CT or MR imaging, it is recommended that the root and ascending aortic diameters be measured from inner-edge to inner-edge, using an electrocardiographic-synchronized technique. If there are aortic wall abnormalities, such as atherosclerosis or discrete wall thickening (more common in the distal aorta), the outer-edge to outer-edge diameter should be reported(Level of Evidence: C-EO)
Recommendations for Imaging in Loeys-Dietz Syndrome
1. In patients with Loeys-Dietz syndrome and a dilated or dissected aorta and/or arterial branches at baseline, annual surveillance imaging of the affected aorta and arteries with MRI or CT is recommended(Level of Evidence: C-EO)
2. In patients with Loeys-Dietz syndrome, a baseline MRI or CT from head to pelvis is recommended to evaluate the entire aorta and its branches for aneurysm, dissection, and tortuosity.(Level of Evidence: C-LD)
1.In patients with Loeys-Dietz syndrome with-out dilation of the aorta distal to the aortic root or ascending aorta and without dilated or dissected arterial branches, surveillance imaging from chest to pelvis with MRI (or CT) every 2 years is reasonable, but imaging may be more frequent depending on family history.(Level of Evidence: C-EO)
2.In patients with Loeys-Dietz syndrome with-out dilation of the cerebral arteries on initial screening, periodic imaging surveillance for cerebral aneurysms with MRI or CT every 2 to 3 years is reasonable.(Level of Evidence: C-EO)
Recommendations for Inflammatory Aortitis: Diagnosis and Treatment of Takayasu Arteritis and GCA Referenced studies that support the recommendations are summarized in the Online Data Supplement
1.In patients with large vessel vasculitis (LVV), prompt evaluation of the entire aorta and branch vessels with MRI or CT, with or without 18F-FDG positron emission tomography (FDG-PET), is recommended.(Level of Evidence: C-LD)
Recommendations for Long-Term Surveillance Imaging After Aortic Dissection and IMH Referenced studies that support the recommendations are summarized in the Online Data Supplement
1. In patients who have had an acute aortic dissection and IMH treated with either open or endovascular aortic repair and have residual aortic disease, surveillance imaging with a CT (or MRI) is recommended after 1 month, 6 months, and 12 months and then, if stable, annually thereafter.(Level of Evidence: B-NR)
2. In patients who have had an acute aortic dissection and IMH that was managed with medical therapy alone, surveillance imaging with a CT (or MRI) is recommended after 1 month, 6 months, and 12 months and then, if stable, annually thereafter.(Level of Evidence: B-NR)
2014 ESC Guidelines on the Diagnosis and Treatment of Aortic Diseases (DO NOT EDIT)[3]
“Repeated imaging study (including CT or MRI) is recommended in case of uncomplicated medially treated aortic dissection type B in the first few days of treatment. (Level of Evidence: C)”
2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease (DO NOT EDIT)[4]
“3. When following patients with imaging, utilization of the same modality at the same institution is reasonable, so that similar images of matching anatomic segments can be compared side by side. (Level of Evidence: C)”
↑Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ (November 2014). “2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC)”. Eur. Heart J. 35 (41): 2873–926. doi:10.1093/eurheartj/ehu281. PMID25173340.
↑ 4.04.14.24.34.44.5Hiratzka LF, Bakris GL, Beckman JA; et al. (2010). “2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine”. Circulation. 121 (13): e266–369. doi:10.1161/CIR.0b013e3181d4739e. PMID20233780. Unknown parameter |month= ignored (help)CS1 maint: Explicit use of et al. (link) CS1 maint: Multiple names: authors list (link)
