Martin R. Prince, MD, PhD, Dasika L. Narasimham, MD, James C

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Presentation transcript:

Gadolinium-enhanced magnetic resonance angiography of abdominal aortic aneurysms Martin R. Prince, MD, PhD, Dasika L. Narasimham, MD, James C. Stanley, MD, Thomas W. Wakefield, MD, Louis M. Messina, MD, Gerald B. Zelenock, MD, William T. Jacoby, MD, M.Victoria Marx, MD, David M. Williams, MD, Kyung J. Cho, MD Journal of Vascular Surgery Volume 21, Issue 4, Pages 656-669 (April 1995) DOI: 10.1016/S0741-5214(95)70197-4 Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Coronal MIP of dynamic gadolinium-enhanced 3D MRA of AAA. Preferential enhancement of arteries allows evaluation of iliac arteries without confounding effects of overlapping veins. However, there is moderate enhancement of renal, splenic, and portal veins). Note left renal artery stenosis (arrow). B, Conventional aortogram. C, Sagittal 2D time-of-flight MRA after gadolinium infusion shows same AAA with thrombus anteriorly, normal preaortic left renal vein, normal celiac trunk, and moderate stenosis of superior mesenteric artery.D-F., Conventional lateral aortogram confirms MRA findings. E, Oblique axial reformation shows proximal renal arteries with moderate left renal artery stenosis (arrow) confirmed by (F) conventional digital subtraction angiography. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Coronal MIP of dynamic gadolinium-enhanced 3D MRA of AAA. Preferential enhancement of arteries allows evaluation of iliac arteries without confounding effects of overlapping veins. However, there is moderate enhancement of renal, splenic, and portal veins). Note left renal artery stenosis (arrow). B, Conventional aortogram. C, Sagittal 2D time-of-flight MRA after gadolinium infusion shows same AAA with thrombus anteriorly, normal preaortic left renal vein, normal celiac trunk, and moderate stenosis of superior mesenteric artery.D-F., Conventional lateral aortogram confirms MRA findings. E, Oblique axial reformation shows proximal renal arteries with moderate left renal artery stenosis (arrow) confirmed by (F) conventional digital subtraction angiography. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Coronal MIP of dynamic gadolinium-enhanced 3D MRA of AAA. Preferential enhancement of arteries allows evaluation of iliac arteries without confounding effects of overlapping veins. However, there is moderate enhancement of renal, splenic, and portal veins). Note left renal artery stenosis (arrow). B, Conventional aortogram. C, Sagittal 2D time-of-flight MRA after gadolinium infusion shows same AAA with thrombus anteriorly, normal preaortic left renal vein, normal celiac trunk, and moderate stenosis of superior mesenteric artery.D-F., Conventional lateral aortogram confirms MRA findings. E, Oblique axial reformation shows proximal renal arteries with moderate left renal artery stenosis (arrow) confirmed by (F) conventional digital subtraction angiography. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Coronal MIP of dynamic gadolinium-enhanced 3D MRA of AAA. Preferential enhancement of arteries allows evaluation of iliac arteries without confounding effects of overlapping veins. However, there is moderate enhancement of renal, splenic, and portal veins). Note left renal artery stenosis (arrow). B, Conventional aortogram. C, Sagittal 2D time-of-flight MRA after gadolinium infusion shows same AAA with thrombus anteriorly, normal preaortic left renal vein, normal celiac trunk, and moderate stenosis of superior mesenteric artery.D-F., Conventional lateral aortogram confirms MRA findings. E, Oblique axial reformation shows proximal renal arteries with moderate left renal artery stenosis (arrow) confirmed by (F) conventional digital subtraction angiography. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Coronal MIP of dynamic gadolinium-enhanced 3D MRA of AAA. Preferential enhancement of arteries allows evaluation of iliac arteries without confounding effects of overlapping veins. However, there is moderate enhancement of renal, splenic, and portal veins). Note left renal artery stenosis (arrow). B, Conventional aortogram. C, Sagittal 2D time-of-flight MRA after gadolinium infusion shows same AAA with thrombus anteriorly, normal preaortic left renal vein, normal celiac trunk, and moderate stenosis of superior mesenteric artery.D-F., Conventional lateral aortogram confirms MRA findings. E, Oblique axial reformation shows proximal renal arteries with moderate left renal artery stenosis (arrow) confirmed by (F) conventional digital subtraction angiography. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 A, Coronal MIP of dynamic gadolinium-enhanced 3D MRA of AAA. Preferential enhancement of arteries allows evaluation of iliac arteries without confounding effects of overlapping veins. However, there is moderate enhancement of renal, splenic, and portal veins). Note left renal artery stenosis (arrow). B, Conventional aortogram. C, Sagittal 2D time-of-flight MRA after gadolinium infusion shows same AAA with thrombus anteriorly, normal preaortic left renal vein, normal celiac trunk, and moderate stenosis of superior mesenteric artery.D-F., Conventional lateral aortogram confirms MRA findings. E, Oblique axial reformation shows proximal renal arteries with moderate left renal artery stenosis (arrow) confirmed by (F) conventional digital subtraction angiography. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Coronal and oblique coronal MIP images (A and B) of aneurysmal changes in aorta and common iliac arteries with visualization of extremely tortuous external iliac arteries.C, D. Axial 2D time-of-flight post-gadolinium image at level of common iliac arteries shows extensive intraluminal thrombus within iliac aneurysm that is confirmed by (D) CT. Note that extensive calcified plaque observed in left common iliac artery on CT (D) is not seen on corresponding MR angiogram (C). Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Coronal and oblique coronal MIP images (A and B) of aneurysmal changes in aorta and common iliac arteries with visualization of extremely tortuous external iliac arteries.C, D. Axial 2D time-of-flight post-gadolinium image at level of common iliac arteries shows extensive intraluminal thrombus within iliac aneurysm that is confirmed by (D) CT. Note that extensive calcified plaque observed in left common iliac artery on CT (D) is not seen on corresponding MR angiogram (C). Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Coronal and oblique coronal MIP images (A and B) of aneurysmal changes in aorta and common iliac arteries with visualization of extremely tortuous external iliac arteries.C, D. Axial 2D time-of-flight post-gadolinium image at level of common iliac arteries shows extensive intraluminal thrombus within iliac aneurysm that is confirmed by (D) CT. Note that extensive calcified plaque observed in left common iliac artery on CT (D) is not seen on corresponding MR angiogram (C). Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Coronal and oblique coronal MIP images (A and B) of aneurysmal changes in aorta and common iliac arteries with visualization of extremely tortuous external iliac arteries.C, D. Axial 2D time-of-flight post-gadolinium image at level of common iliac arteries shows extensive intraluminal thrombus within iliac aneurysm that is confirmed by (D) CT. Note that extensive calcified plaque observed in left common iliac artery on CT (D) is not seen on corresponding MR angiogram (C). Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Coronal MIP image of infrarenal aortoaortic graft with recurrent saccular aneurysm (arrow) just below graft distal anastomosis. Note surgical clip artifacts (arrowhead). B, Conventional angiogram confirms MRA findings. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 A, Coronal MIP image of infrarenal aortoaortic graft with recurrent saccular aneurysm (arrow) just below graft distal anastomosis. Note surgical clip artifacts (arrowhead). B, Conventional angiogram confirms MRA findings. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 MRA AAA diameter measurements versus CT (square) and ultrasound (triangle) AAA diameter measurements. Solid line corresponds to perfect agreement. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Axial and B, sagittal 2D time-of-flight image obtained after gadolinium infusion shows extensive infiltration/enhancement of preaortic tissue (arrows) consistent with inflammatory aneurysm that was confirmed at operation. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Axial and B, sagittal 2D time-of-flight image obtained after gadolinium infusion shows extensive infiltration/enhancement of preaortic tissue (arrows) consistent with inflammatory aneurysm that was confirmed at operation. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 6 Coronal MIP of leaking AAA. Contained rupture at left margin of aneurysm (arrow) was confirmed at emergency operation. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 A, Coronal MIP shows dissection involving abdominal aorta and common iliac arteries. Large reentry tears are seen at level of renal arteries (open arrow) and in left common iliac artery (curved arrow). B, Intimal flap also well seen at level of the left renal artery on axial 2D time-of-flight image obtained after gadolinium (arrows). Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 7 A, Coronal MIP shows dissection involving abdominal aorta and common iliac arteries. Large reentry tears are seen at level of renal arteries (open arrow) and in left common iliac artery (curved arrow). B, Intimal flap also well seen at level of the left renal artery on axial 2D time-of-flight image obtained after gadolinium (arrows). Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 8 Grading of visceral and iliac arterial stenoses by MRA compared with angiography and intraoperative evaluation. MRA grading matched other grading in 141 arteries and was off by one grade in 12 arteries. Overall sensitivity for detecting significant stenoses was 33 of 35 (94%), and specificity was 116 of 118 (98%). Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 (A) Coronal MIP and (B) subvolume MIP of infrarenal AAA with bilateral renal artery stenoses (arrows). After AAA repair with bilateral renal artery endarterectomy (C) there is improved visualization of renal arteries and increased renal parenchymal enhancement. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 (A) Coronal MIP and (B) subvolume MIP of infrarenal AAA with bilateral renal artery stenoses (arrows). After AAA repair with bilateral renal artery endarterectomy (C) there is improved visualization of renal arteries and increased renal parenchymal enhancement. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 9 (A) Coronal MIP and (B) subvolume MIP of infrarenal AAA with bilateral renal artery stenoses (arrows). After AAA repair with bilateral renal artery endarterectomy (C) there is improved visualization of renal arteries and increased renal parenchymal enhancement. Journal of Vascular Surgery 1995 21, 656-669DOI: (10.1016/S0741-5214(95)70197-4) Copyright © 1995 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions