Simon Veldhoen MD, Presenter: Nothing to Disclose

Cyrus Behzadi, Abstract Co-Author: Nothing to Disclose

Thorsten Derlin, Abstract Co-Author: Nothing to Disclose

Meike Rybczinsky, Abstract Co-Author: Nothing to Disclose

Yskert von Kodolitsch, Abstract Co-Author: Nothing to Disclose

Sara Sheikhzadeh, Abstract Co-Author: Nothing to Disclose

Frank Oliver Gerhard Henes MD, Abstract Co-Author: Nothing to Disclose

Thorsten Alexander Bley MD, Abstract Co-Author: Nothing to Disclose

Gerhard B. Adam MD, Abstract Co-Author: Nothing to Disclose

Peter Bannas MD, Abstract Co-Author: Nothing to Disclose

Annual imaging of the aortic root is recommended for Marfan patients. Unenhanced MRI allows for avoidance of nephrogenic systemic fibrosis, allergic reactions and contrast paravasation. In this context, we compared non-ECG-gated contrast-enhanced 3D MRA (CE-MRA) and ECG-gated non-contrast 2D steady-state-free precession (SSFP) imaging for monitoring of the aortic diameters in patients with Marfan syndrome (MFS).

3D CE-MRA and non-contrast 2D SSFP at 1.5T were prospectively performed in 50 patients with confirmed MFS (24 males; age 34.7±13.8). Two readers independently measured aortic diameters at the sinuses of Valsalva, sinutubular junction, ascending aorta, aortic arch and descending aorta. Image quality was assessed on a three-point scale at each level. Aortic root diameters acquired by echocardiography were used as reference standard.

Intra- and interobserver variances of measurements were significantly smaller for 2D SSFP at the sinuses of Valsalva (SSFP, 95% limit of agreement ±0.31cm vs. CE-MRA, ±0.69cm; p=0.002 and SSFP, 95% limit of agreement, ±0.37cm vs. CE-MRA, ±0.59cm; p=0.002) and sinutubular junction (p=0.014 and p=0.043). Image quality was rated significantly better for 2D SSFP than for 3D CE-MRA at sinuses of Valsalva (p<0.0001), sinutubular junction (p<0.0001) and ascending aorta (p=0.02). 3D CE-MRA yielded significantly higher diameters than 2D SSFP measurements at the sinuses of Valsalva (mean bias 0.25cm, p<0.0001), and comparison with echocardiography confirmed a higher bias (0.72±0.34cm) for 3D CE-MRA when compared to 2D SSFP (0.47±0.26cm).

ECG-gated non-contrast 2D SSFP imaging provides superior image quality with higher reproducibility and validity due to decreased motion artifacts compared to non-ECG-gated contrast-enhanced 3D imaging. Since 3D CE-MRA overestimates the diameter of the aortic root and requires administration of contrast agents with potential adverse effects, 2D SSFP imaging should be preferred for exact and riskless monitoring of aortic diameters in MFS patients.

ECG-gated non-contrast 2D SSFP imaging should be preferred for monitoring of aortic diameters in Marfan patients.

Veldhoen, S, Behzadi, C, Derlin, T, Rybczinsky, M, von Kodolitsch, Y, Sheikhzadeh, S, Henes, F, Bley, T, Adam, G, Bannas, P, Monitoring of Aortic Diameters in Patients with Marfan Syndrome: Intraindividual Comparison of 3D CE-MRA and 2D SSFP Imaging.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14006585.html