Abstract
Aortic coarctation accounts for 5%–10% of all congenital heart diseases and represents 7% of critically ill infants with heart disease. Magnetic resonance (MR) imaging allows the study of this disease with several advantages in comparison with conventional angiography, transesophageal echocardiography, and computed tomography. The MR protocol applied at our institution for both diagnosis and follow-up after surgical or endovascular treatment consists of four steps: morphologic study, cine MR study, flow analysis, and MR angiography (MRA). The first three sequences are acquired during breath-hold and with electrocardiographic gating. Anatomy is well depicted with dark-blood half-Fourier acquisition single-shot turbo spin-echo (HASTE) sequences. Cine true-fast imaging with steady-state precession (true-FISP) sequences show not only morphologic features but also blood-flow changes inside the aorta. Gradient-echo sequences for phase-velocity mapping allow flow analysis. Application of Bernoulli’s equation — here briefly presented and discussed — allows for calculation of the pressure gradient caused by the coarctation. MRA, acquired with a breath-hold three-dimensional T1-weighted gradient-echo sequence and intravenous administration of paramagnetic contrast material, allows for optimal depiction of the aortic lumen, with a panoramic view of the whole aorta, its main branches and possible collateral circulation.
Riassunto
La coartazione aortica rappresenta il 5%–10% di tutte le patologie congenite del cuore e dei grandi vasi e il 7% dei casi di piccoli cardiopatici in condizioni critiche. La risonanza magnetica (RM) permette lo studio di questa patologia con una serie di vantaggi rispetto a tecniche alternative quali l’angiografia convenzionale, l’ecografia transesofagea e la tomografia computerizzata. Il nostro protocollo RM, utilizzato sia per la diagnosi, sia per il follow-up dopo trattamento chirurgico o endovascolare, consiste di quattro fasi: studio morfologico, cinetico, flussimetria e angio-RM. Le prime tre sequenze sono acquisite in apnea e con sincronizzazione elettrocardiografica. L’anatomia è studiata con sequenze a sangue scuro half-Fourier acquisition single shot turbo spin-echo (HASTE). Le sequenze a sangue chiaro true-fast imaging with steady-state precession (true-FISP), oltre a dare informazioni di tipo morfologico, mostrano le alterazioni del flusso ematico all’interno del vaso. Le sequenze gradient-echo con mappaggio fase-velocità consentono la quantificazione del flusso; l’applicazione dell’equazione di Bernoulli (qui brevemente presentata e discussa), consente infatti il calcolo del gradiente pressorio determinato dalla coartazione. Lo studio angio-RM, ottenuto in apnea mediante sequenze gradient-echo tridimensionali T1-pesate con somministrazione endovenosa di mezzo di contrasto paramagnetico, mostra una visione volumetrica panoramica del lume dell’aorta, delle sue principali ramificazioni e, quando presenti, dei circoli collaterali.
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References/Bibliografia
Shah SN, Calderon DM (2008) Aortic coarctation. E-medicine. Medscape Continually updated clinical reference (http://emedicine.medscape.com/article/150369-overview). Accessed 02/2009
Jarcho S. (1961) Coarctation of the aorta (Meckel, 1750; Paris, 1791). Am J Cardiol; 7:844–852
Morgagni GB (1761) De sedibus et causis morborum per anatomen indagatis. Typ. Remondiniana, Benetiis
Paris M (1791) Rétrècissement considerable de l’aorte pectoral observe à l’Hotel Dieu de Paris. Jour de Chirurgie de Desault ii:107
Abbott ME (1928) Statistical study and historical retrospect of 200 recorded cases, with autopsy, of stenosis or obliteration of the descending arch in subjects above the age of two years. Am Heart J 3:392–421
Lewis T (1933) Material relating to coarctation of the adult type. Br Heart J 16:205–261
Martin ML, Adams MM, Mortensen ML (1990) Descriptive epidemiology of selected malformations of the aorta, Atlanta, 1970–1983. Teratology 42:273–283
Grech V (1999) Diagnostic and surgical trends, and epidemiology of coarctation of the aorta in a population-based study. Int J Cardiol 68:197–202
Samánek M, Slavík Z, Zborilová B et al (1989) Prevalence, treatment, and outcome of heart disease in live-born children: a prospective analysis of 91,823 live-born children. Pediatr Cardiol 10:205–211
Rao PS (2005) Coarctation of the aorta. Curr Cardiol Rep 7:425–434
Warnes CA (2003) Bicuspid aortic valve and coarctation: two villains part of a diffuse problem. Heart 89:965–966
Rosenquist TH, Beall AC, Modis L (1990) Impaired elastic matrix development in the great arteries after ablation of the neural crest. Anat Rec 226:347–359
Jenkins NP, Ward C (1999) Coarctation of the aorta: natural history and outcome after surgical treatment. QJM 92:365–371
Friedman WF (1997) Congenital heart disease in infancy and childhood. In: Braunwald E (ed) Heart disease: a textbook of cardiovascular medicine. WB Saunders, Philadelphia, pp 877–962
Valdes-Cruz LM, Cayre RO (1998) Echocardiographic diagnosis of congenital heart disease. Lippincott-Raven, Philadelphia
Prisant LM, Mawulawde K, Kapoor D, Joe C (2004) Coarctation of the aorta: a secondary cause of hypertension. J Clin Hypertens 6:347–352
Bouchart F, Dubar A, Tabley A et al (2000) Coarctation of the aorta in adults: surgical results and long-term follow-up. Ann Thorac Surg 70:1483–1488
Crafoord C, Nylin G (1945) Congenital coarctation of the aorta and its surgical treatment. J Thorac Surg 14:347–361
Vosschulte K (1961) Surgical correction of coarctation of the aorta by an “isthmusplastic’ operation. Thorax 16:338–345
Rothman A (1998) Interventional therapy for coarctation of the aorta. Curr Opin Cardiol 13:66–72
Singer MI, Rowen M, Dorsy TJ (1982) Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J 103:131–132
Suarez de Lezo J, Pan M, Romero M et al (1995) Balloon-expandable stent repair of severe coarctation of the aorta. Am Heart J 129:1002–1008
Rubay JE, Sluysmans T, Alexandrescu V et al (1992) Surgical repair of coarctation of the aorta in infants under one year of age: long term results in 146 patients comparing subclavian flap angioplasty and modified end to end anastomosis. J Cardiovasc Surg 33:216–222
Bobby JJ, Emami JM, Farmer RD, Newman CGH (1991) Operative survival and 40 year follow up of surgical repair of aortic coarctation. Br Heart J 65:271–276
Cittadini G, Cittadini G jr, Sardanelli F (2008) Cuore. In: Diagnostica per immagini e radioterapia. Ecig, Genova, p 430
Sbarzaglia P, Lovato L, Buttazzi K et al (2006) Interventional techniques in the treatment of aortic dissection. Radiol Med 111:585–596
de Roos A, Roest AA (2000) Evaluation of congenital heart disease by magnetic resonance imaging. Eur Radiol 10:2–6
Fattori R, Nienaber CA (1999) MRI of acute and chronic aortic pathology: preoperative and postoperative evaluation. J Magn Reson Imaging 10:741–750
Carr JC, Simonetti O, Bundy J et al (2001) Cine MR angiography of the heart with segmented true fast imaging with steady-state precession. Radiology 219:828–834
Caruthers SD, Lin SJ, Brown P et al (2003) Practical value of cardiac magnetic resonance imaging for clinical quantification of aortic valve stenosis: comparison with echocardiography. Circulation 108:2236–2243
Rebergen SA, van der Wall EE, Doornbos J et al (1993) Magnetic resonance measurement of velocity and flow: technique, validation, and cardiovascular applications. Am Heart J 126:1439–1456
Ho VB, Prince MR (1998) Thoracic MR aortography: imaging techniques and strategies. Radiographics 18:287–309
Riehle TJ, Oshinski JN (2006) Velocity-encoded magnetic resonance image assessment of regional aortic flow in coarctation patients. Ann Thorac Surg 81:1002–1007
Godart F, Labrot G, Devos P et al (2002) Coarctation of the aorta: comparison of aortic dimensions between conventional MR imaging, 3D MR angiography, and conventional angiography. Eur Radiol 12:2034–2039
Boxt LM (1996) How to perform cardiac MR imaging. Magn Reson Imaging Clin N Am 4:191–216
Madore B, Henkelman RM (1994) Motion artifacts in fast spin-echo imaging. J Magn Reson Imaging 4:577–584
Imura C (1998) HASTE: features and clinical applications. Nippon Rinsho 56:2778–2782
Iozzelli A, D’Orta G, Aliprandi A (2008) The value of true-FISP sequence added to conventional gadolinium-enhanced MRA of abdominal aorta and its major branches. Eur J Radiol [Epub ahead of print]
Chatzimavroudis GP, Oshinski JN, Franch RH et al (2001) Evaluation of the precision of magnetic resonance phase velocity mapping for blood flow measurements. J Cardiovasc Magn Reson 3:11–19
Mohaiddin RH, Kilner PJ (2002) Valvular heart disease. In: Manniong WJ, Pennel DJ (eds) Cardiovascular magnetic resonance. Churchill Livingstone, New York, pp 389–390
Konen E, Merchant N, Provost Y et al (2004) Coarctation of the aorta before and after correction: the role of cardiovascular MRI. AJR Am J Roentgenol 182:1333–1339
Campbell M (1970) Natural history of coarctation of the aorta. Br Heart J 32:633–640
Runge VM (2001) Safety of magnetic resonance contrast media. Top Magn Reson Imaging 12:309–314
Thomsen HS (2007) ESUR guideline: gadolinium-based contrast media and nephrogenic systemic fibrosis. Eur Radiol 17:2692–2696
Deo A, Fogel M, Cowper SE (2007) Nephrogenic systemic fibrosis: a population study examining the relationship of disease development to gadolinium exposure. Clin J Am Soc Nephrol 2:264–267
Prince MR, Zhang H, Morris M et al (2008) Incidence of nephrogenic systemic fibrosis at two large medical centers. Radiology 248:807–816
Persson A, Brismar TB, Lundstrom C et al (2006) Standardized volume rendering for magnetic resonance angiography measurements in the abdominal aorta. Acta Radiol 47:172–178
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Secchi, F., Iozzelli, A., Papini, G.D.E. et al. MR imaging of aortic coarctation. Radiol med 114, 524–537 (2009). https://doi.org/10.1007/s11547-009-0386-6
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DOI: https://doi.org/10.1007/s11547-009-0386-6
Keywords
- Aorta
- Aortic coarctation
- Bernoulli’s equation
- Magnetic resonance (MR) imaging
- MR flow analysis (phase-velocity mapping)