Click on any image below to see an enlargement of that image.

Case 1: Normal tricuspid aortic valve	Case 2: Aortitis
	Inversion recovery image demonstrates edema within the aortic wall
Case 3: Elderly patient with aortic stenosis
(A) Cross section through bicuspid aortic valve	(B) Three chamber view showing aortic jet secondary to acquired calcific aortic stenosis
Case 4: Saccular atherosclerotic aneurysm	Case 5: Saccular mycotic aneurysm
Case 6: Child with complex congenital heart disease and history of repair of Transposition of the Great Vessels	Case 7: Abdominal aortic dissection
Right ventricle (RV), left ventricle (LV), aorta (A), main pulmonary artery (PA), surgically created conduit (C)	Three dimensional angiogram showing true lumen (small arrow) and false lumen (large arrow)
Case 8: Right sided aortic arch with aberrant left subclavian artery (large arrow) and diverticulum of Kommerol (small arrow)

Above images are all original MR scans performed at Parkside MR Center.

Discussion

MRI has emerged as a mainstay in the noninvasive evaluation of the thoracoabdominal aorta. MRI is indicated in a variety of acquired and congenital conditions including aortic aneurysm, dissection, coarctation and suspected vascular ring. Using contrast enhanced three-dimensional time of flight techniques, MRI rivals conventional angiography in evaluation of thoracic aortic disease¹. With the addition of newer MR techniques, including breath-hold ECG gated black blood imaging and cineangiography, the utility of MR in diagnosing aortic disease has substantially increased. With current techniques, for example, MRI is more accurate than transesophageal echocardiography in the diagnosis of aortic dissection².

The role of MRI in evaluation of cardiac valvular morphology and function is changing rapidly. MRI provides excellent static representation of valvular anatomy using dark blood techniques³ and can yield substantial semiquantitative information about valvular function using MR cineangiography. The jets of signal void associated with valvular stenosis and regurgitation on cine MR are analogous to those demonstrated by Doppler echocardiography. MRI clearly has a better reproducibility rate than Doppler echocardiography and should be the method of choice for monitoring patients with significant valvular disease⁴.

In future issues of UPDATE we will highlight our exciting new work in other areas of cardiac MRI, including volumetric analysis, regional wall motion using myocardial tagging, first pass myocardial perfusion, and myocardial viability.

References:

1. Krinsky, G.A., Rofsky, N.M., DeCorato, D.R., Weinreb, J.C., Earls, J.P., Flyer, M.A., Galloway, A.C., Colvin, S.B. Thoracic aorta: Comparison of gadolinium-enhanced three-dimensional MR angiography with conventional MR imaging. Radiology 1997; 202:183-193.

2. Fattori, R., Nienaber, C.A. MRI of acute and chronic aortic pathology: pre-operative and postoperative evaluation. J Mag Reson Imaging 1999; 10:741-750.

3. Arai, A.E., Epstein, F.H., Bove, K.E., Wolf, S.D. Visualization of aortic valve leaflets using black blood MRI. J Mag Reson Imaging 1999; 10:771-777.

4. Sondergaard, L., Stahlberg, F., Thomsen, C. Magnetic resonance imaging of valvular heart disease. J Mag Reson Imaging 1999; 10:627-638.

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