MRA of Abdominal Aortic Aneurysms Martin R. Prince, MD, PhD www.Mrprotocols.com.

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Presentation transcript:

MRA of Abdominal Aortic Aneurysms Martin R. Prince, MD, PhD

AAA Definition Normal Abdominal Aorta = cm* Aneurysmal Abdominal Aorta > 3 cm* *measure outer wall to outer wall 6.9 cm

AAA Natural History Expansion rate = 2-4 mm/year –Larger aneurysms expand faster than small diameter aneurysms –> 5mm in 6 months  risk of rupture Risk of Rupture (over 5 years) < 4 cm2%follow 4-5 cm3-12% +/- repair > 5 cm25-41%repair 9.2 cm

Imaging AAA Ultrasound- screening and following CT- suspected rupture - following with precision MRA- pre-operative planning - following with precision Angio- contraindication to MR - resolving issues - stent graft placement Ultrasound

AAA Surgical Mortality Elective:4% 6% w/ late complications Ruptured:49% (23%-69%) CT shows aortic rupture

AAA MRA Technique Sag T1 or SSFSE7 min Coronal 3D Gd MRA 30s x 3 Axial 2D TOF post Gd7 min Axial 3D PC (Venc = 30 cm/sec)8min Total imaging time~24 minutes Sequences Time Sag T1

3D Gd MRA Gd dose = 40 ml Gd bolus timing is critical SmartPrep  8 sec image acquisition delay 3 mm slices: Zip  1.5mm Include iliac arteries Exclude anterior part of AAA

Check iliac Artery Position

Axial 2D Time of Flight Post Gd Thick slices 4 NEX Respiratory compersation No saturation pulse Cover from celiac to femoral head Use large Gap (10-20 cm)

Axial 3D PC Post Gd 2.5 mm slice thickness encode in all 3 directions Venc = 30 cm/sec reconstruct overlapping axial MIPs

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy Associated Aneurysms Occlusive Disease Anatomic Variants

AAA Classification Thoraco abdominal suprarenal pararenal juxtarenal infrarenal Thick MIPThinner MIP

Suprarenal AAA Aneurysm ends above celiac Sag Oblique MIP

AAA Classification Thoraco abdominal suprarenal pararenal juxtarenal infrarenal Coronal MIP Sagittal MIP

Pararenal Coronal MIP Sagittal MIP Axial MIP Renal artery arises from aneurysm

AAA Classification Thoraco abdominal suprarenal pararenal juxtarenal infrarenal Coronal MIP

Juxtarenal 9mm Aneurysm begins within 1 cm of renal artery origins: Clamp above renals

AAA Classification Thoraco abdominal suprarenal pararenal juxtarenal infrarenal Thick MIP Thinner MIP

Infrarenal AAA > 1cm between AAA & renal artery 3.2 cm

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy Associated Aneurysms Occlusive Disease Anatomic Variants

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy Associated Aneurysms Occlusive Disease Anatomic Variants

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy Associated Aneurysms Occlusive Disease Anatomic Variants Retroperitoneal enhancement

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy Associated Aneurysms Occlusive Disease Anatomic Variants

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy –dissecting Associated Aneurysms Occlusive Disease Anatomic Variants

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy Associated Aneurysms Occlusive Disease Anatomic Variants

Aneurysms associated with AAA thoracic aorta iliac common femoral popliteal renal visceral Coronal MIPSag MIP

Renal Artery Aneurysms

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy Associated Aneurysms Occlusive Disease Anatomic Variants Coronal MIP

Post tube graft: iliac aneurysms left renal artery stenosis Coronal MIPMag Coronal thin MIP

AAA Surgical Planning Issues Proximal extent: classification Distal Extent Size Character –inflammatory –shaggy Associated Aneurysms Occlusive Disease Anatomic Variants

AAA w/accessory renal arteries

Retroaortic left renal vein

Summary MRA for pre-op AAA evaluation Gd is essential No nephrotoxicity Analyze data systematically