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DOI: 10.1148/rg.275065737
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Three-dimensional Contrast-enhanced MR Angiography of Aortic Dissection: A Pictorial Essay1

Qi Liu, MD, Jian Ping Lu, MD, Fei Wang, MD, Li Wang, MD, and Jian Min Tian, MD

1 From the Department of Radiology, Changhai Hospital/2nd Military Med University, 174 Changhai Rd, Shanghai, Shanghai 200433, China. Received October 18, 2006; revision requested February 2, 2007; revision received March 8; accepted March 12. All authors have no financial relationships to disclose.

Figure 1A
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  		Figure 1a.  Intimal flap in a Stan-ford type A aortic dissection. (a) Oblique sagittal sub-MIP image depicts an intimal flap (arrowheads) between the true lumen (1) and the false lumen (2) extending from the ascending aortic root to the abdominal aorta. (b) Axial MPR image at the level of the pulmonary trunk depicts the arc-shaped intimal flap (arrowheads), the oval true lumen (1), and the crescentic false lumen (2) in both the ascending and descending aorta.

 

Figure 1B
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  		Figure 1b.  Intimal flap in a Stan-ford type A aortic dissection. (a) Oblique sagittal sub-MIP image depicts an intimal flap (arrowheads) between the true lumen (1) and the false lumen (2) extending from the ascending aortic root to the abdominal aorta. (b) Axial MPR image at the level of the pulmonary trunk depicts the arc-shaped intimal flap (arrowheads), the oval true lumen (1), and the crescentic false lumen (2) in both the ascending and descending aorta.

 

Figure 2A
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  		Figure 2a.  Differing signal intensities and anatomic relationships of the true and false lumina. Coronal MIP images show a hyperintense true lumen (1) and a hypointense false lumen (2). The lumina are relatively parallel in a, the true lumen looks like a ribbon floating in the false lumen in b, and the false lumen winds around the true lumen in c.

 

Figure 2B
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  		Figure 2b.  Differing signal intensities and anatomic relationships of the true and false lumina. Coronal MIP images show a hyperintense true lumen (1) and a hypointense false lumen (2). The lumina are relatively parallel in a, the true lumen looks like a ribbon floating in the false lumen in b, and the false lumen winds around the true lumen in c.

 

Figure 2C
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  		Figure 2c.  Differing signal intensities and anatomic relationships of the true and false lumina. Coronal MIP images show a hyperintense true lumen (1) and a hypointense false lumen (2). The lumina are relatively parallel in a, the true lumen looks like a ribbon floating in the false lumen in b, and the false lumen winds around the true lumen in c.

 

Figure 3A
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  		Figure 3a.  Initial entry in a Stanford type B aortic dissection. (a) Axial MPR image at the level of the aortic arch demonstrates the initial entry (arrowhead) but does not depict its 3D relationship to the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (b, c) Clipped oblique sagittal VR images clearly depict the morphologic features and size (2.35 cm) of the initial entry (arrowhead in b), which is about 1.85 cm from the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (d) VE image shows the free edge of the intimal flap (arrowhead) at the initial entry site from inside the aortic lumen. 1 = true lumen, 2 = false lumen. (e, f) On DSA images (more contrast material used to obtain f than e), the initial entry is not clearly depicted regardless of the amount of contrast agent used.

 

Figure 3B
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  		Figure 3b.  Initial entry in a Stanford type B aortic dissection. (a) Axial MPR image at the level of the aortic arch demonstrates the initial entry (arrowhead) but does not depict its 3D relationship to the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (b, c) Clipped oblique sagittal VR images clearly depict the morphologic features and size (2.35 cm) of the initial entry (arrowhead in b), which is about 1.85 cm from the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (d) VE image shows the free edge of the intimal flap (arrowhead) at the initial entry site from inside the aortic lumen. 1 = true lumen, 2 = false lumen. (e, f) On DSA images (more contrast material used to obtain f than e), the initial entry is not clearly depicted regardless of the amount of contrast agent used.

 

Figure 3C
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  		Figure 3c.  Initial entry in a Stanford type B aortic dissection. (a) Axial MPR image at the level of the aortic arch demonstrates the initial entry (arrowhead) but does not depict its 3D relationship to the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (b, c) Clipped oblique sagittal VR images clearly depict the morphologic features and size (2.35 cm) of the initial entry (arrowhead in b), which is about 1.85 cm from the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (d) VE image shows the free edge of the intimal flap (arrowhead) at the initial entry site from inside the aortic lumen. 1 = true lumen, 2 = false lumen. (e, f) On DSA images (more contrast material used to obtain f than e), the initial entry is not clearly depicted regardless of the amount of contrast agent used.

 

Figure 3D
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  		Figure 3d.  Initial entry in a Stanford type B aortic dissection. (a) Axial MPR image at the level of the aortic arch demonstrates the initial entry (arrowhead) but does not depict its 3D relationship to the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (b, c) Clipped oblique sagittal VR images clearly depict the morphologic features and size (2.35 cm) of the initial entry (arrowhead in b), which is about 1.85 cm from the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (d) VE image shows the free edge of the intimal flap (arrowhead) at the initial entry site from inside the aortic lumen. 1 = true lumen, 2 = false lumen. (e, f) On DSA images (more contrast material used to obtain f than e), the initial entry is not clearly depicted regardless of the amount of contrast agent used.

 

Figure 3E
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  		Figure 3e.  Initial entry in a Stanford type B aortic dissection. (a) Axial MPR image at the level of the aortic arch demonstrates the initial entry (arrowhead) but does not depict its 3D relationship to the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (b, c) Clipped oblique sagittal VR images clearly depict the morphologic features and size (2.35 cm) of the initial entry (arrowhead in b), which is about 1.85 cm from the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (d) VE image shows the free edge of the intimal flap (arrowhead) at the initial entry site from inside the aortic lumen. 1 = true lumen, 2 = false lumen. (e, f) On DSA images (more contrast material used to obtain f than e), the initial entry is not clearly depicted regardless of the amount of contrast agent used.

 

Figure 3F
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  		Figure 3f.  Initial entry in a Stanford type B aortic dissection. (a) Axial MPR image at the level of the aortic arch demonstrates the initial entry (arrowhead) but does not depict its 3D relationship to the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (b, c) Clipped oblique sagittal VR images clearly depict the morphologic features and size (2.35 cm) of the initial entry (arrowhead in b), which is about 1.85 cm from the left subclavian artery orifice. 1 = true lumen, 2 = false lumen. (d) VE image shows the free edge of the intimal flap (arrowhead) at the initial entry site from inside the aortic lumen. 1 = true lumen, 2 = false lumen. (e, f) On DSA images (more contrast material used to obtain f than e), the initial entry is not clearly depicted regardless of the amount of contrast agent used.

 

Figure 4
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  		Figure 4.  Initial entry in a Stanford type A aortic dissection. Clipped coronal VR images reveal the initial entry (arrowhead) at the right wall of the ascending aortic root, about 2.23 cm above the aortic valvular ring. 1 = true lumen, 2 = false lumen.

 

Figure 5A
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  		Figure 5a.  Initial entry in a Stanford type B aortic dissection. (a, b) Clipped oblique posteroanterior VR images show the initial entry (arrowhead) at the descending junction of the aortic arch, about 9.92 mm from the origin of the left subclavian artery. 1 = true lumen, 2 = false lumen. (c) On a DSA image, the relationship of the initial entry to the left subclavian artery is not as clearly depicted.

 

Figure 5B
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  		Figure 5b.  Initial entry in a Stanford type B aortic dissection. (a, b) Clipped oblique posteroanterior VR images show the initial entry (arrowhead) at the descending junction of the aortic arch, about 9.92 mm from the origin of the left subclavian artery. 1 = true lumen, 2 = false lumen. (c) On a DSA image, the relationship of the initial entry to the left subclavian artery is not as clearly depicted.

 

Figure 5C
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  		Figure 5c.  Initial entry in a Stanford type B aortic dissection. (a, b) Clipped oblique posteroanterior VR images show the initial entry (arrowhead) at the descending junction of the aortic arch, about 9.92 mm from the origin of the left subclavian artery. 1 = true lumen, 2 = false lumen. (c) On a DSA image, the relationship of the initial entry to the left subclavian artery is not as clearly depicted.

 

Figure 6A
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  		Figure 6a.  Differing locations of the reentry site. Clipped coronal VR images show the reentry site at the left iliac artery (arrowhead in a), the right external iliac artery (arrowhead in b), and the common iliac arteries (arrowheads in c). 1 = true lumen, 2 = false lumen.

 

Figure 6B
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  		Figure 6b.  Differing locations of the reentry site. Clipped coronal VR images show the reentry site at the left iliac artery (arrowhead in a), the right external iliac artery (arrowhead in b), and the common iliac arteries (arrowheads in c). 1 = true lumen, 2 = false lumen.

 

Figure 6C
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  		Figure 6c.  Differing locations of the reentry site. Clipped coronal VR images show the reentry site at the left iliac artery (arrowhead in a), the right external iliac artery (arrowhead in b), and the common iliac arteries (arrowheads in c). 1 = true lumen, 2 = false lumen.

 

Figure 7A
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  		Figure 7a.  Differing locations of the reentry site. Clipped coronal VR images show the reentry site at the abdominal aorta (arrowhead in a), the origin of the right renal artery (arrowhead in b), and the origin of the celiac artery (CA) (arrowhead in c). SMA = superior mesenteric artery, 1 = true lumen, 2 = false lumen.

 

Figure 7B
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  		Figure 7b.  Differing locations of the reentry site. Clipped coronal VR images show the reentry site at the abdominal aorta (arrowhead in a), the origin of the right renal artery (arrowhead in b), and the origin of the celiac artery (CA) (arrowhead in c). SMA = superior mesenteric artery, 1 = true lumen, 2 = false lumen.

 

Figure 7C
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  		Figure 7c.  Differing locations of the reentry site. Clipped coronal VR images show the reentry site at the abdominal aorta (arrowhead in a), the origin of the right renal artery (arrowhead in b), and the origin of the celiac artery (CA) (arrowhead in c). SMA = superior mesenteric artery, 1 = true lumen, 2 = false lumen.

 

Figure 8A
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  		Figure 8a.  Involvement of the abdominal aortic branches in a Stanford type A aortic dissection. Clipped coronal VR image (a) and axial MPR images (b–d) at the level of the orifice of the abdominal aortic branches show that the celiac artery (CA) originates from both the true (1) and false (2) lumina, the left renal artery (LRA) originates from the false lumen, and the superior mesenteric artery (SMA) and right renal artery (RRA) originate from the true lumen. Arrowheads in a indicate the reentry site.

 

Figure 8B
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  		Figure 8b.  Involvement of the abdominal aortic branches in a Stanford type A aortic dissection. Clipped coronal VR image (a) and axial MPR images (b–d) at the level of the orifice of the abdominal aortic branches show that the celiac artery (CA) originates from both the true (1) and false (2) lumina, the left renal artery (LRA) originates from the false lumen, and the superior mesenteric artery (SMA) and right renal artery (RRA) originate from the true lumen. Arrowheads in a indicate the reentry site.

 

Figure 8C
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  		Figure 8c.  Involvement of the abdominal aortic branches in a Stanford type A aortic dissection. Clipped coronal VR image (a) and axial MPR images (b–d) at the level of the orifice of the abdominal aortic branches show that the celiac artery (CA) originates from both the true (1) and false (2) lumina, the left renal artery (LRA) originates from the false lumen, and the superior mesenteric artery (SMA) and right renal artery (RRA) originate from the true lumen. Arrowheads in a indicate the reentry site.

 

Figure 8D
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  		Figure 8d.  Involvement of the abdominal aortic branches in a Stanford type A aortic dissection. Clipped coronal VR image (a) and axial MPR images (b–d) at the level of the orifice of the abdominal aortic branches show that the celiac artery (CA) originates from both the true (1) and false (2) lumina, the left renal artery (LRA) originates from the false lumen, and the superior mesenteric artery (SMA) and right renal artery (RRA) originate from the true lumen. Arrowheads in a indicate the reentry site.

 

Figure 9A
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  		Figure 9a.  Thrombosis of the false lumen in a Stanford type B aortic dissection. (a) Clipped sagittal VR image shows an apparent thrombus (arrowheads) in the proximal end of the false lumen (2). LSCA = left subclavian artery. (b, c) Coronal (b) and axial (c) MPR images more clearly depict the thrombus (arrowheads). 1 = true lumen, 2 = false lumen.

 

Figure 9B
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  		Figure 9b.  Thrombosis of the false lumen in a Stanford type B aortic dissection. (a) Clipped sagittal VR image shows an apparent thrombus (arrowheads) in the proximal end of the false lumen (2). LSCA = left subclavian artery. (b, c) Coronal (b) and axial (c) MPR images more clearly depict the thrombus (arrowheads). 1 = true lumen, 2 = false lumen.

 

Figure 9C
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  		Figure 9c.  Thrombosis of the false lumen in a Stanford type B aortic dissection. (a) Clipped sagittal VR image shows an apparent thrombus (arrowheads) in the proximal end of the false lumen (2). LSCA = left subclavian artery. (b, c) Coronal (b) and axial (c) MPR images more clearly depict the thrombus (arrowheads). 1 = true lumen, 2 = false lumen.

 

Figure 10A
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  		Figure 10a.  Intramural hematoma in a Stanford type A aortic dissection. (a) On a clipped sagittal VR image, the aorta appears to be normal. (b, c) Sagittal (b) and axial (c) MPR images clearly delineate a thick, unenhanced hematoma (arrowheads) in the medial layer of the ascending and descending aorta.

 

Figure 10B
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  		Figure 10b.  Intramural hematoma in a Stanford type A aortic dissection. (a) On a clipped sagittal VR image, the aorta appears to be normal. (b, c) Sagittal (b) and axial (c) MPR images clearly delineate a thick, unenhanced hematoma (arrowheads) in the medial layer of the ascending and descending aorta.

 

Figure 10C
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  		Figure 10c.  Intramural hematoma in a Stanford type A aortic dissection. (a) On a clipped sagittal VR image, the aorta appears to be normal. (b, c) Sagittal (b) and axial (c) MPR images clearly delineate a thick, unenhanced hematoma (arrowheads) in the medial layer of the ascending and descending aorta.

 

Figure 11A
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  		Figure 11a.  Complete and dynamic display of a Stanford type B aortic dissection. (a, b) Clipped coronal arterial phase (a) and oblique sagittal venous phase (b) VR images demonstrate the initial entry (black arrowhead) at the middle segment of the descending aorta and the reentry site (white arrowhead) at the orifice of the left renal artery. (c, d) DSA images demonstrate the initial entry (c) and the reentry site (d).

 

Figure 11B
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  		Figure 11b.  Complete and dynamic display of a Stanford type B aortic dissection. (a, b) Clipped coronal arterial phase (a) and oblique sagittal venous phase (b) VR images demonstrate the initial entry (black arrowhead) at the middle segment of the descending aorta and the reentry site (white arrowhead) at the orifice of the left renal artery. (c, d) DSA images demonstrate the initial entry (c) and the reentry site (d).

 

Figure 11C
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  		Figure 11c.  Complete and dynamic display of a Stanford type B aortic dissection. (a, b) Clipped coronal arterial phase (a) and oblique sagittal venous phase (b) VR images demonstrate the initial entry (black arrowhead) at the middle segment of the descending aorta and the reentry site (white arrowhead) at the orifice of the left renal artery. (c, d) DSA images demonstrate the initial entry (c) and the reentry site (d).

 

Figure 11D
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  		Figure 11d.  Complete and dynamic display of a Stanford type B aortic dissection. (a, b) Clipped coronal arterial phase (a) and oblique sagittal venous phase (b) VR images demonstrate the initial entry (black arrowhead) at the middle segment of the descending aorta and the reentry site (white arrowhead) at the orifice of the left renal artery. (c, d) DSA images demonstrate the initial entry (c) and the reentry site (d).

 

Figure 12A
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  		Figure 12a.  Pre- and postoperative assessment of a Stanford type B aortic dissection in a 46-year-old man. (a, b) Clipped oblique sagittal (a) and coronal (b) VR images depict a type B aortic dissection of the descending aorta involving the upper segment of the abdominal aorta and the orifice of the celiac artery. 1 = true lumen, 2 = false lumen. (c, d) Clipped oblique sagittal (c) and coronal (d) VR images obtained 1 month after surgery show elimination of the false lumen, with only a small cavity around the reentry site (arrowhead).

 

Figure 12B
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  		Figure 12b.  Pre- and postoperative assessment of a Stanford type B aortic dissection in a 46-year-old man. (a, b) Clipped oblique sagittal (a) and coronal (b) VR images depict a type B aortic dissection of the descending aorta involving the upper segment of the abdominal aorta and the orifice of the celiac artery. 1 = true lumen, 2 = false lumen. (c, d) Clipped oblique sagittal (c) and coronal (d) VR images obtained 1 month after surgery show elimination of the false lumen, with only a small cavity around the reentry site (arrowhead).

 

Figure 12C
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  		Figure 12c.  Pre- and postoperative assessment of a Stanford type B aortic dissection in a 46-year-old man. (a, b) Clipped oblique sagittal (a) and coronal (b) VR images depict a type B aortic dissection of the descending aorta involving the upper segment of the abdominal aorta and the orifice of the celiac artery. 1 = true lumen, 2 = false lumen. (c, d) Clipped oblique sagittal (c) and coronal (d) VR images obtained 1 month after surgery show elimination of the false lumen, with only a small cavity around the reentry site (arrowhead).

 

Figure 12D
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  		Figure 12d.  Pre- and postoperative assessment of a Stanford type B aortic dissection in a 46-year-old man. (a, b) Clipped oblique sagittal (a) and coronal (b) VR images depict a type B aortic dissection of the descending aorta involving the upper segment of the abdominal aorta and the orifice of the celiac artery. 1 = true lumen, 2 = false lumen. (c, d) Clipped oblique sagittal (c) and coronal (d) VR images obtained 1 month after surgery show elimination of the false lumen, with only a small cavity around the reentry site (arrowhead).

 




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