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Gadolinium-enhanced Three-dimensional MR Angiography of Takayasu Arteritis¹

¹ From the Institute of Radiology (M.V.N., R.H.B., R.B., C.C.L., G.G.C.) and Heart Institute (L.P.S.B., L.F.d.A., C.C.d.C.), University of São Paulo Medical School, São Paulo, Brazil. Recipient of an Excellence in Design award at the 2002 RSNA scientific assembly. Received April 7, 2003; revision requested June 8 and received January 28, 2004; accepted February 4. All authors have no financial relationships to disclose. Address correspondence to M.V.N., Rua Itambe 289, ap 507, 01239-001 São Paulo, SP, Brazil (e-mail: marcionastri@yahoo.com).

View larger version (110K): [in a new window]   Figure 1.  System for classifying Takayasu arteritis according to the site of involvement.

View larger version (188K): [in a new window]   Figure 2.  Type I Takayasu arteritis in a 25-year-old woman. Axial US scan of the left common carotid artery shows concentric thickening of the vessel wall.

View larger version (170K): [in a new window]   Figure 3.  Type I Takayasu arteritis in a 31-year-old woman. Coronal digital subtraction angiogram of the supraaortic vessels shows focal stenosis of the proximal portion of the left subclavian artery (large arrow). The right subclavian artery is aberrant. There is severe stenosis at the origin of the right vertebral artery (small arrow). The right common carotid artery (arrowheads) is almost occluded at its origin and is retrogradely filled by collateral vessels.

View larger version (126K): [in a new window]   Figure 4a.  Type IIb Takayasu arteritis with pulmonary artery involvement in a 30-year-old woman. (a) Axial contrast material-enhanced multidetector-row CT scan shows stenosis and wall thickening of the left common carotid artery at its origin (arrow). (b, c) Axial contrast-enhanced multidetector-row CT scans (b obtained at a higher level than c) show occlusion of the right descending interlobar artery (arrow). (d) Axial contrast-enhanced multidetector-row CT scan from the same examination shows absence of enhanced vessels in the right lower lobe. There is also mild wall thickening of the descending thoracic aorta.

View larger version (101K): [in a new window]   Figure 4b.  Type IIb Takayasu arteritis with pulmonary artery involvement in a 30-year-old woman. (a) Axial contrast material-enhanced multidetector-row CT scan shows stenosis and wall thickening of the left common carotid artery at its origin (arrow). (b, c) Axial contrast-enhanced multidetector-row CT scans (b obtained at a higher level than c) show occlusion of the right descending interlobar artery (arrow). (d) Axial contrast-enhanced multidetector-row CT scan from the same examination shows absence of enhanced vessels in the right lower lobe. There is also mild wall thickening of the descending thoracic aorta.

View larger version (104K): [in a new window]   Figure 4c.  Type IIb Takayasu arteritis with pulmonary artery involvement in a 30-year-old woman. (a) Axial contrast material-enhanced multidetector-row CT scan shows stenosis and wall thickening of the left common carotid artery at its origin (arrow). (b, c) Axial contrast-enhanced multidetector-row CT scans (b obtained at a higher level than c) show occlusion of the right descending interlobar artery (arrow). (d) Axial contrast-enhanced multidetector-row CT scan from the same examination shows absence of enhanced vessels in the right lower lobe. There is also mild wall thickening of the descending thoracic aorta.

View larger version (105K): [in a new window]   Figure 4d.  Type IIb Takayasu arteritis with pulmonary artery involvement in a 30-year-old woman. (a) Axial contrast material-enhanced multidetector-row CT scan shows stenosis and wall thickening of the left common carotid artery at its origin (arrow). (b, c) Axial contrast-enhanced multidetector-row CT scans (b obtained at a higher level than c) show occlusion of the right descending interlobar artery (arrow). (d) Axial contrast-enhanced multidetector-row CT scan from the same examination shows absence of enhanced vessels in the right lower lobe. There is also mild wall thickening of the descending thoracic aorta.

View larger version (163K): [in a new window]   Figure 5a.  Type I Takayasu arteritis. (a) Coronal maximum intensity projection (MIP) 3D MR angiogram of a 33-year-old woman shows significant stenosis of the right common carotid artery at its origin (small arrow). The left subclavian artery has two stenotic segments (large arrows) with a small area of poststenotic dilatation in between. There are also some luminal irregularities of the left common carotid artery. (b) Coronal MIP 3D MR angiogram of a 23-year-old woman shows irregularities of the distal portion of the brachiocephalic trunk (left small arrow) and of the left common carotid artery (right small arrow). There is an abrupt stenosis at the origin of the left subclavian artery (large arrow). (c) Coronal MIP 3D MR angiogram of a 35-year-old woman shows high-grade stenosis of the left common carotid artery (arrow). (d) Axial T1-weighted MR image (obtained before administration of gadolinium contrast material) of the same patient as in c shows wall thickening of the left common carotid artery (arrow).

View larger version (146K): [in a new window]   Figure 5b.  Type I Takayasu arteritis. (a) Coronal maximum intensity projection (MIP) 3D MR angiogram of a 33-year-old woman shows significant stenosis of the right common carotid artery at its origin (small arrow). The left subclavian artery has two stenotic segments (large arrows) with a small area of poststenotic dilatation in between. There are also some luminal irregularities of the left common carotid artery. (b) Coronal MIP 3D MR angiogram of a 23-year-old woman shows irregularities of the distal portion of the brachiocephalic trunk (left small arrow) and of the left common carotid artery (right small arrow). There is an abrupt stenosis at the origin of the left subclavian artery (large arrow). (c) Coronal MIP 3D MR angiogram of a 35-year-old woman shows high-grade stenosis of the left common carotid artery (arrow). (d) Axial T1-weighted MR image (obtained before administration of gadolinium contrast material) of the same patient as in c shows wall thickening of the left common carotid artery (arrow).

View larger version (129K): [in a new window]   Figure 5c.  Type I Takayasu arteritis. (a) Coronal maximum intensity projection (MIP) 3D MR angiogram of a 33-year-old woman shows significant stenosis of the right common carotid artery at its origin (small arrow). The left subclavian artery has two stenotic segments (large arrows) with a small area of poststenotic dilatation in between. There are also some luminal irregularities of the left common carotid artery. (b) Coronal MIP 3D MR angiogram of a 23-year-old woman shows irregularities of the distal portion of the brachiocephalic trunk (left small arrow) and of the left common carotid artery (right small arrow). There is an abrupt stenosis at the origin of the left subclavian artery (large arrow). (c) Coronal MIP 3D MR angiogram of a 35-year-old woman shows high-grade stenosis of the left common carotid artery (arrow). (d) Axial T1-weighted MR image (obtained before administration of gadolinium contrast material) of the same patient as in c shows wall thickening of the left common carotid artery (arrow).

View larger version (149K): [in a new window]   Figure 5d.  Type I Takayasu arteritis. (a) Coronal maximum intensity projection (MIP) 3D MR angiogram of a 33-year-old woman shows significant stenosis of the right common carotid artery at its origin (small arrow). The left subclavian artery has two stenotic segments (large arrows) with a small area of poststenotic dilatation in between. There are also some luminal irregularities of the left common carotid artery. (b) Coronal MIP 3D MR angiogram of a 23-year-old woman shows irregularities of the distal portion of the brachiocephalic trunk (left small arrow) and of the left common carotid artery (right small arrow). There is an abrupt stenosis at the origin of the left subclavian artery (large arrow). (c) Coronal MIP 3D MR angiogram of a 35-year-old woman shows high-grade stenosis of the left common carotid artery (arrow). (d) Axial T1-weighted MR image (obtained before administration of gadolinium contrast material) of the same patient as in c shows wall thickening of the left common carotid artery (arrow).

View larger version (105K): [in a new window]   Figure 6a.  Type IIa Takayasu arteritis in a 27-year-old woman. Axial unenhanced (a) and gadolinium-enhanced (b) T1-weighted MR images show wall thickening of the ascending aorta (arrow), which is enhanced on the gadolinium-enhanced image (b).

View larger version (147K): [in a new window]   Figure 6b.  Type IIa Takayasu arteritis in a 27-year-old woman. Axial unenhanced (a) and gadolinium-enhanced (b) T1-weighted MR images show wall thickening of the ascending aorta (arrow), which is enhanced on the gadolinium-enhanced image (b).

View larger version (159K): [in a new window]   Figure 7a.  Type IIb Takayasu arteritis in a 24-year-old man. (a) Coronal MIP 3D MR angiogram shows stenosis at the origin of the right subclavian artery (small arrow). There is also diffuse narrowing of both common carotid arteries (arrowheads) and focal stenosis of the left subclavian artery (large arrow). (b) Sagittal MIP 3D MR angiogram from the same examination shows stenosis of the descending thoracic aorta (arrowhead). (c) Sagittal T1-weighted MR image (obtained before administration of gadolinium contrast material) shows thickening of the aortic wall.

View larger version (54K): [in a new window]   Figure 7b.  Type IIb Takayasu arteritis in a 24-year-old man. (a) Coronal MIP 3D MR angiogram shows stenosis at the origin of the right subclavian artery (small arrow). There is also diffuse narrowing of both common carotid arteries (arrowheads) and focal stenosis of the left subclavian artery (large arrow). (b) Sagittal MIP 3D MR angiogram from the same examination shows stenosis of the descending thoracic aorta (arrowhead). (c) Sagittal T1-weighted MR image (obtained before administration of gadolinium contrast material) shows thickening of the aortic wall.

View larger version (131K): [in a new window]   Figure 7c.  Type IIb Takayasu arteritis in a 24-year-old man. (a) Coronal MIP 3D MR angiogram shows stenosis at the origin of the right subclavian artery (small arrow). There is also diffuse narrowing of both common carotid arteries (arrowheads) and focal stenosis of the left subclavian artery (large arrow). (b) Sagittal MIP 3D MR angiogram from the same examination shows stenosis of the descending thoracic aorta (arrowhead). (c) Sagittal T1-weighted MR image (obtained before administration of gadolinium contrast material) shows thickening of the aortic wall.

View larger version (98K): [in a new window]   Figure 8a.  Type III Takayasu arteritis. (a) Coronal MIP 3D MR angiogram of a 30-year-old woman shows irregular dilatation of the descending thoracic aorta and proximal abdominal aorta. (b) Oblique MIP 3D MR angiogram of a 10-year-old girl shows diffuse narrowing of the descending thoracic and abdominal aorta (arrowheads) and the common iliac arteries with an aortoaortic graft (arrows). (c) Oblique MIP 3D MR angiogram of a 34-year-old woman shows irregular dilatation of the descending thoracic aorta and proximal abdominal aorta and narrowing of the infrarenal aorta. (d) Axial T1-weighted MR image of the same patient as in c shows the narrowed infrarenal aorta (arrow).

View larger version (85K): [in a new window]   Figure 8b.  Type III Takayasu arteritis. (a) Coronal MIP 3D MR angiogram of a 30-year-old woman shows irregular dilatation of the descending thoracic aorta and proximal abdominal aorta. (b) Oblique MIP 3D MR angiogram of a 10-year-old girl shows diffuse narrowing of the descending thoracic and abdominal aorta (arrowheads) and the common iliac arteries with an aortoaortic graft (arrows). (c) Oblique MIP 3D MR angiogram of a 34-year-old woman shows irregular dilatation of the descending thoracic aorta and proximal abdominal aorta and narrowing of the infrarenal aorta. (d) Axial T1-weighted MR image of the same patient as in c shows the narrowed infrarenal aorta (arrow).

View larger version (59K): [in a new window]   Figure 8c.  Type III Takayasu arteritis. (a) Coronal MIP 3D MR angiogram of a 30-year-old woman shows irregular dilatation of the descending thoracic aorta and proximal abdominal aorta. (b) Oblique MIP 3D MR angiogram of a 10-year-old girl shows diffuse narrowing of the descending thoracic and abdominal aorta (arrowheads) and the common iliac arteries with an aortoaortic graft (arrows). (c) Oblique MIP 3D MR angiogram of a 34-year-old woman shows irregular dilatation of the descending thoracic aorta and proximal abdominal aorta and narrowing of the infrarenal aorta. (d) Axial T1-weighted MR image of the same patient as in c shows the narrowed infrarenal aorta (arrow).

View larger version (77K): [in a new window]   Figure 8d.  Type III Takayasu arteritis. (a) Coronal MIP 3D MR angiogram of a 30-year-old woman shows irregular dilatation of the descending thoracic aorta and proximal abdominal aorta. (b) Oblique MIP 3D MR angiogram of a 10-year-old girl shows diffuse narrowing of the descending thoracic and abdominal aorta (arrowheads) and the common iliac arteries with an aortoaortic graft (arrows). (c) Oblique MIP 3D MR angiogram of a 34-year-old woman shows irregular dilatation of the descending thoracic aorta and proximal abdominal aorta and narrowing of the infrarenal aorta. (d) Axial T1-weighted MR image of the same patient as in c shows the narrowed infrarenal aorta (arrow).

View larger version (97K): [in a new window]   Figure 9a.  Type IV Takayasu arteritis. (a) Oblique MIP 3D MR angiogram of a 32-year-old woman shows occlusion of the infrarenal aorta (arrow). The right kidney is not visualized. (b) Coronal MIP 3D MR angiogram of a 19-year-old woman shows irregular dilatation of the abdominal aorta and iliac arteries. Each renal artery has a short stenotic segment at its origin (arrows). (c) Sagittal 3D MR angiogram of a 30-year-old man shows a long stenotic segment of the superior mesenteric artery (arrowheads) and focal stenosis of the celiac trunk (arrow). (d) Coronal MIP 3D MR angiogram of a 21-year-old woman shows irregular stenosis of the abdominal aorta (arrows) and common iliac arteries (arrowheads). The right kidney is small due to concomitant involvement of the renal artery.

View larger version (107K): [in a new window]   Figure 9b.  Type IV Takayasu arteritis. (a) Oblique MIP 3D MR angiogram of a 32-year-old woman shows occlusion of the infrarenal aorta (arrow). The right kidney is not visualized. (b) Coronal MIP 3D MR angiogram of a 19-year-old woman shows irregular dilatation of the abdominal aorta and iliac arteries. Each renal artery has a short stenotic segment at its origin (arrows). (c) Sagittal 3D MR angiogram of a 30-year-old man shows a long stenotic segment of the superior mesenteric artery (arrowheads) and focal stenosis of the celiac trunk (arrow). (d) Coronal MIP 3D MR angiogram of a 21-year-old woman shows irregular stenosis of the abdominal aorta (arrows) and common iliac arteries (arrowheads). The right kidney is small due to concomitant involvement of the renal artery.

View larger version (79K): [in a new window]   Figure 9c.  Type IV Takayasu arteritis. (a) Oblique MIP 3D MR angiogram of a 32-year-old woman shows occlusion of the infrarenal aorta (arrow). The right kidney is not visualized. (b) Coronal MIP 3D MR angiogram of a 19-year-old woman shows irregular dilatation of the abdominal aorta and iliac arteries. Each renal artery has a short stenotic segment at its origin (arrows). (c) Sagittal 3D MR angiogram of a 30-year-old man shows a long stenotic segment of the superior mesenteric artery (arrowheads) and focal stenosis of the celiac trunk (arrow). (d) Coronal MIP 3D MR angiogram of a 21-year-old woman shows irregular stenosis of the abdominal aorta (arrows) and common iliac arteries (arrowheads). The right kidney is small due to concomitant involvement of the renal artery.

View larger version (91K): [in a new window]   Figure 9d.  Type IV Takayasu arteritis. (a) Oblique MIP 3D MR angiogram of a 32-year-old woman shows occlusion of the infrarenal aorta (arrow). The right kidney is not visualized. (b) Coronal MIP 3D MR angiogram of a 19-year-old woman shows irregular dilatation of the abdominal aorta and iliac arteries. Each renal artery has a short stenotic segment at its origin (arrows). (c) Sagittal 3D MR angiogram of a 30-year-old man shows a long stenotic segment of the superior mesenteric artery (arrowheads) and focal stenosis of the celiac trunk (arrow). (d) Coronal MIP 3D MR angiogram of a 21-year-old woman shows irregular stenosis of the abdominal aorta (arrows) and common iliac arteries (arrowheads). The right kidney is small due to concomitant involvement of the renal artery.

View larger version (121K): [in a new window]   Figure 10a.  Type IV Takayasu arteritis in a 25-year-old woman. (a) Coronal MIP 3D MR angiogram shows narrowing of the abdominal aorta (arrow). The narrowing starts below the celiac trunk and is associated with stenosis of the renal arteries (top arrowheads) and the left common iliac artery (bottom arrowhead). There are also luminal irregularities of the right common iliac artery; the left nephrogram is barely visible. (b-e) Axial unenhanced (b, c) and gadolinium-enhanced (d, e) T1-weighted MR images (b and d obtained at a higher level than c and e) show thickening of the aortic wall with involvement of adjacent tissues (arrow in b and c). These structures are enhanced on the gadolinium-enhanced images (arrow in d and e), a finding that denotes inflammation.

View larger version (91K): [in a new window]   Figure 10b.  Type IV Takayasu arteritis in a 25-year-old woman. (a) Coronal MIP 3D MR angiogram shows narrowing of the abdominal aorta (arrow). The narrowing starts below the celiac trunk and is associated with stenosis of the renal arteries (top arrowheads) and the left common iliac artery (bottom arrowhead). There are also luminal irregularities of the right common iliac artery; the left nephrogram is barely visible. (b-e) Axial unenhanced (b, c) and gadolinium-enhanced (d, e) T1-weighted MR images (b and d obtained at a higher level than c and e) show thickening of the aortic wall with involvement of adjacent tissues (arrow in b and c). These structures are enhanced on the gadolinium-enhanced images (arrow in d and e), a finding that denotes inflammation.

View larger version (85K): [in a new window]   Figure 10c.  Type IV Takayasu arteritis in a 25-year-old woman. (a) Coronal MIP 3D MR angiogram shows narrowing of the abdominal aorta (arrow). The narrowing starts below the celiac trunk and is associated with stenosis of the renal arteries (top arrowheads) and the left common iliac artery (bottom arrowhead). There are also luminal irregularities of the right common iliac artery; the left nephrogram is barely visible. (b-e) Axial unenhanced (b, c) and gadolinium-enhanced (d, e) T1-weighted MR images (b and d obtained at a higher level than c and e) show thickening of the aortic wall with involvement of adjacent tissues (arrow in b and c). These structures are enhanced on the gadolinium-enhanced images (arrow in d and e), a finding that denotes inflammation.

View larger version (122K): [in a new window]   Figure 10d.  Type IV Takayasu arteritis in a 25-year-old woman. (a) Coronal MIP 3D MR angiogram shows narrowing of the abdominal aorta (arrow). The narrowing starts below the celiac trunk and is associated with stenosis of the renal arteries (top arrowheads) and the left common iliac artery (bottom arrowhead). There are also luminal irregularities of the right common iliac artery; the left nephrogram is barely visible. (b-e) Axial unenhanced (b, c) and gadolinium-enhanced (d, e) T1-weighted MR images (b and d obtained at a higher level than c and e) show thickening of the aortic wall with involvement of adjacent tissues (arrow in b and c). These structures are enhanced on the gadolinium-enhanced images (arrow in d and e), a finding that denotes inflammation.

View larger version (120K): [in a new window]   Figure 10e.  Type IV Takayasu arteritis in a 25-year-old woman. (a) Coronal MIP 3D MR angiogram shows narrowing of the abdominal aorta (arrow). The narrowing starts below the celiac trunk and is associated with stenosis of the renal arteries (top arrowheads) and the left common iliac artery (bottom arrowhead). There are also luminal irregularities of the right common iliac artery; the left nephrogram is barely visible. (b-e) Axial unenhanced (b, c) and gadolinium-enhanced (d, e) T1-weighted MR images (b and d obtained at a higher level than c and e) show thickening of the aortic wall with involvement of adjacent tissues (arrow in b and c). These structures are enhanced on the gadolinium-enhanced images (arrow in d and e), a finding that denotes inflammation.

View larger version (108K): [in a new window]   Figure 11a.  Type V Takayasu arteritis. (a) Oblique MIP 3D MR angiogram of a 19-year-old woman shows irregular narrowing of the descending thoracic aorta and abdominal aorta with scattered areas of small aneurysms. The marginal artery of Drummond is prominent (arrow). (b) Sagittal MIP 3D MR angiogram from the same examination shows concomitant involvement of the supraaortic branches. (c, d) Oblique MIP 3D MR angiograms (c obtained at a higher level than d) of a 31-year-old woman show irregular dilatation and kinking of the entire aorta.

View larger version (104K): [in a new window]   Figure 11b.  Type V Takayasu arteritis. (a) Oblique MIP 3D MR angiogram of a 19-year-old woman shows irregular narrowing of the descending thoracic aorta and abdominal aorta with scattered areas of small aneurysms. The marginal artery of Drummond is prominent (arrow). (b) Sagittal MIP 3D MR angiogram from the same examination shows concomitant involvement of the supraaortic branches. (c, d) Oblique MIP 3D MR angiograms (c obtained at a higher level than d) of a 31-year-old woman show irregular dilatation and kinking of the entire aorta.

View larger version (135K): [in a new window]   Figure 11c.  Type V Takayasu arteritis. (a) Oblique MIP 3D MR angiogram of a 19-year-old woman shows irregular narrowing of the descending thoracic aorta and abdominal aorta with scattered areas of small aneurysms. The marginal artery of Drummond is prominent (arrow). (b) Sagittal MIP 3D MR angiogram from the same examination shows concomitant involvement of the supraaortic branches. (c, d) Oblique MIP 3D MR angiograms (c obtained at a higher level than d) of a 31-year-old woman show irregular dilatation and kinking of the entire aorta.

View larger version (137K): [in a new window]   Figure 11d.  Type V Takayasu arteritis. (a) Oblique MIP 3D MR angiogram of a 19-year-old woman shows irregular narrowing of the descending thoracic aorta and abdominal aorta with scattered areas of small aneurysms. The marginal artery of Drummond is prominent (arrow). (b) Sagittal MIP 3D MR angiogram from the same examination shows concomitant involvement of the supraaortic branches. (c, d) Oblique MIP 3D MR angiograms (c obtained at a higher level than d) of a 31-year-old woman show irregular dilatation and kinking of the entire aorta.

View larger version (154K): [in a new window]   Figure 12a.  Type V Takayasu arteritis. (a, b) Coronal (a) and sagittal (b) MIP 3D MR angiograms of a 31-year-old woman show two stenotic segments of the right subclavian artery (arrowheads in a), occlusion of the left subclavian artery (arrow), and narrowing of the descending thoracic and abdominal aorta (arrowhead in b). (c) Axial double inversion recovery fast spin-echo MR image of the same patient shows thickening of the aortic wall (arrow). (d) Oblique MIP 3D MR angiogram of a 35-year-old woman shows dilatation of the ascending aorta (small arrows) and diffuse and subtle narrowing of the descending thoracic and abdominal aorta (large arrows).

View larger version (86K): [in a new window]   Figure 12b.  Type V Takayasu arteritis. (a, b) Coronal (a) and sagittal (b) MIP 3D MR angiograms of a 31-year-old woman show two stenotic segments of the right subclavian artery (arrowheads in a), occlusion of the left subclavian artery (arrow), and narrowing of the descending thoracic and abdominal aorta (arrowhead in b). (c) Axial double inversion recovery fast spin-echo MR image of the same patient shows thickening of the aortic wall (arrow). (d) Oblique MIP 3D MR angiogram of a 35-year-old woman shows dilatation of the ascending aorta (small arrows) and diffuse and subtle narrowing of the descending thoracic and abdominal aorta (large arrows).

View larger version (135K): [in a new window]   Figure 12c.  Type V Takayasu arteritis. (a, b) Coronal (a) and sagittal (b) MIP 3D MR angiograms of a 31-year-old woman show two stenotic segments of the right subclavian artery (arrowheads in a), occlusion of the left subclavian artery (arrow), and narrowing of the descending thoracic and abdominal aorta (arrowhead in b). (c) Axial double inversion recovery fast spin-echo MR image of the same patient shows thickening of the aortic wall (arrow). (d) Oblique MIP 3D MR angiogram of a 35-year-old woman shows dilatation of the ascending aorta (small arrows) and diffuse and subtle narrowing of the descending thoracic and abdominal aorta (large arrows).

View larger version (135K): [in a new window]   Figure 12d.  Type V Takayasu arteritis. (a, b) Coronal (a) and sagittal (b) MIP 3D MR angiograms of a 31-year-old woman show two stenotic segments of the right subclavian artery (arrowheads in a), occlusion of the left subclavian artery (arrow), and narrowing of the descending thoracic and abdominal aorta (arrowhead in b). (c) Axial double inversion recovery fast spin-echo MR image of the same patient shows thickening of the aortic wall (arrow). (d) Oblique MIP 3D MR angiogram of a 35-year-old woman shows dilatation of the ascending aorta (small arrows) and diffuse and subtle narrowing of the descending thoracic and abdominal aorta (large arrows).