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MRA of Abdominal Aortic Aneurysms

MRA of Abdominal Aortic Aneurysms. Martin R. Prince, MD, PhD. www.Mrprotocols.com. AAA Definition. Normal Abdominal Aorta = 1.4-2.1 cm* Aneurysmal Abdominal Aorta > 3 cm* *measure outer wall to outer wall. 6.9 cm. www.Mrprotocols.com. 9.2 cm. AAA Natural History.

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MRA of Abdominal Aortic Aneurysms

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  1. MRA ofAbdominal Aortic Aneurysms Martin R. Prince, MD, PhD www.Mrprotocols.com

  2. AAA Definition Normal Abdominal Aorta = 1.4-2.1 cm* Aneurysmal Abdominal Aorta > 3 cm* *measure outer wall to outer wall 6.9 cm www.Mrprotocols.com

  3. 9.2 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 cm 2% follow 4-5 cm 3-12% +/- repair > 5 cm 25-41% repair www.Mrprotocols.com

  4. 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 Imaging AAA www.Mrprotocols.com

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

  6. AAA MRA Technique • Sag T1 or SSFSE 7 min • Coronal 3D Gd MRA 30s x 3 • Axial 2D TOF post Gd 7 min • Axial 3D PC (Venc = 30 cm/sec) 8min Total imaging time ~24 minutes Sequences Time Sag T1 www.Mrprotocols.com

  7. 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 www.Mrprotocols.com

  8. Check iliac Artery Position www.Mrprotocols.com

  9. 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) www.Mrprotocols.com

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

  11. AAA Surgical Planning Issues • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • Associated Aneurysms • Occlusive Disease • Anatomic Variants www.Mrprotocols.com

  12. AAA Classification • Thoraco abdominal • suprarenal • pararenal • juxtarenal • infrarenal Thick MIP Thinner MIP www.Mrprotocols.com

  13. Suprarenal AAAAneurysm ends above celiac Sag Oblique MIP www.Mrprotocols.com

  14. AAA Classification • Thoraco abdominal • suprarenal • pararenal • juxtarenal • infrarenal Sagittal MIP Coronal MIP www.Mrprotocols.com

  15. Pararenal Renal artery arises from aneurysm Sagittal MIP Axial MIP Coronal MIP www.Mrprotocols.com

  16. AAA Classification • Thoraco abdominal • suprarenal • pararenal • juxtarenal • infrarenal Coronal MIP www.Mrprotocols.com

  17. Juxtarenal Aneurysm begins within 1 cm of renal artery origins: Clamp above renals 9mm www.Mrprotocols.com

  18. AAA Classification • Thoraco abdominal • suprarenal • pararenal • juxtarenal • infrarenal Thinner MIP Thick MIP www.Mrprotocols.com

  19. Infrarenal AAA> 1cm between AAA & renal artery 3.2 cm www.Mrprotocols.com

  20. AAA Surgical Planning Issues • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • Associated Aneurysms • Occlusive Disease • Anatomic Variants www.Mrprotocols.com

  21. AAA Surgical Planning Issues • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • Associated Aneurysms • Occlusive Disease • Anatomic Variants www.Mrprotocols.com

  22. AAA Surgical Planning Issues Retroperitoneal enhancement • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • Associated Aneurysms • Occlusive Disease • Anatomic Variants www.Mrprotocols.com

  23. AAA Surgical Planning Issues • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • Associated Aneurysms • Occlusive Disease • Anatomic Variants www.Mrprotocols.com

  24. www.Mrprotocols.com AAA Surgical Planning Issues • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • dissecting • Associated Aneurysms • Occlusive Disease • Anatomic Variants

  25. AAA Surgical Planning Issues • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • Associated Aneurysms • Occlusive Disease • Anatomic Variants www.Mrprotocols.com

  26. Aneurysms associated with AAA • thoracic aorta • iliac • common femoral • popliteal • renal • visceral Coronal MIP Sag MIP www.Mrprotocols.com

  27. Renal Artery Aneurysms www.Mrprotocols.com

  28. AAA Surgical Planning Issues • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • Associated Aneurysms • Occlusive Disease • Anatomic Variants Coronal MIP www.Mrprotocols.com

  29. Post tube graft:iliac aneurysmsleft renal artery stenosis Coronal MIP Mag Coronal thin MIP www.Mrprotocols.com

  30. AAA Surgical Planning Issues • Proximal extent: classification • Distal Extent • Size • Character • inflammatory • shaggy • Associated Aneurysms • Occlusive Disease • Anatomic Variants www.Mrprotocols.com

  31. AAA w/accessory renal arteries www.Mrprotocols.com

  32. Retroaortic left renal vein www.Mrprotocols.com

  33. Summary • MRA for pre-op AAA evaluation • Gd is essential • No nephrotoxicity • Analyze data systematically www.Mrprotocols.com

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