Diagnostic challenge: innovative approach in use of magnetic resonance imaging in aortic aneurysm

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Abstract

Here we report a case of technological innovation: the use of magnetic resonance imaging to determine surgical strategy.

Here is a 47-year-old man who underwent an magnetic resonance imaging and subsequent surgical treatment of the aortic aneurysm. Unlike echocardiography, magnetic resonance imaging enabled us to view the entire thoracic aorta. Unlike computer tomography, magnetic resonance imaging enabled us to detect changes in the aortic wall accurately. Thus, in this case, the use of magnetic resonance imaging allowed us to determine the distal resection edge. The patient`s postoperative course was unremarkable. Use of electrocardiogram-synchronized magnetic resonance imaging of thoracic aorta allows detecting structural changes of the aortic wall and its mechanical properties. It is significant that magnetic resonance imaging results of the aortic wall correlate with histologic examination.

The extent of changes in the aortic wall must be determined to accurately plan surgical treatment of patients with aortic aneurism.

Magnetic resonance imaging of the aortic wall is promising for further study in multicenter research.

About the authors

Evgenii Kobelev

E. Meshalkin National Medical Research Center

Email: kobelev_e@meshalkin.ru
ORCID iD: 0000-0002-5901-2271
SPIN-code: 7828-9713
Russian Federation, Novosibirsk

Natalya T. Pak

E. Meshalkin National Medical Research Center

Email: n_pak@meshalkin.ru
ORCID iD: 0000-0002-7842-9881
SPIN-code: 1896-8447

MD, Cand. Sci. (Med.)

Russian Federation, Novosibirsk

Evgeniya E. Bobrikova

E. Meshalkin National Medical Research Center

Email: bobrikova_e@meshalkin.ru
ORCID iD: 0000-0001-5985-4076
SPIN-code: 6315-9772
Russian Federation, Novosibirsk

Wladimir Y. Ussov

Tomsk National Research Medical Center

Email: ussov1962@yandex.ru
ORCID iD: 0000-0001-7978-5514
SPIN-code: 1299-2074

MD, Dr. Sci. (Med.), Professor

Russian Federation, Tomsk

Evgeniy E. Kliver

E. Meshalkin National Medical Research Center

Email: ee_kliver@meshalkin.ru
ORCID iD: 0000-0002-3915-3616
SPIN-code: 1511-3814

MD, Dr. Sci. (Med.)

Russian Federation, Novosibirsk

Dmitriy A. Sirota

E. Meshalkin National Medical Research Center

Email: d_sirota@meshalkin.ru
ORCID iD: 0000-0002-9940-3541
SPIN-code: 4706-7549

MD, Cand. Sci. (Med.)

Russian Federation, Novosibirsk

Aleksandr M. Chernyavskiy

E. Meshalkin National Medical Research Center

Email: a_cherniavsky@meshalkin.ru
ORCID iD: 0000-0001-9818-8678
SPIN-code: 5286-6950

MD, Dr. Sci. (Med.), Professor, Corresponding member of the Russian Academy of Sciences

Russian Federation, Novosibirsk

Tatyanа A. Bergen

E. Meshalkin National Medical Research Center

Author for correspondence.
Email: bergen_t@meshalkin.ru
ORCID iD: 0000-0003-1530-1327
SPIN-code: 5467-7347

MD, Dr. Sci. (Med.)

Russian Federation, Novosibirsk

References

  1. Erbel R, Aboyans V, Boileau C. et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European society of cardiology (ESC). Eur Heart J. 2014;35(41):2873–926. doi: 10.1093/eurheartj/ehu281
  2. Hiratzka LF, Bakris GL, Beckman JA, et al. Guidelines for the diagnosis and management of patients with thoracic aortic disease. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol. 2010;55(14):e27–e129.
  3. Galizia MS, Bolen MA, Flamm S. MRI of the thoracic aorta. Applied Radiology. 2015;44(8):22–26. doi: 10.37549/ar2207
  4. Saliba E, Sia Y. The ascending aortic aneurysm: When to intervene? IJC Heart Vasculature. 2015;6:91–100. doi: 10.1016/j.ijcha.2015.01.009

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2. Fig. 1. Images obtained in the SSFP mode in the axial (a) and coronal (b) planes, T1-SE (middle third of the aortic aneurysm) in the axial plane (c), T1-SPIR in the "black blood" mode in the oblique plane (d ). Thinned wall of the aorta, more pronounced in the middle part.

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3. Fig. 2. MR-contrast enhancement angiography, arterial phase, in breath-hold, in the oblique plane, 3D reconstruction of the aorta (a), T1-SPIR-BB imaging, axial plane (b) immediately after distal aneurysm edge of ascending aorta; oblique plane (c) before orifice of the brachiocephalic trunk. The intact thickness of the aortic wall (arrows), CT angiography of the thoracic aorta after surgical treatment (d).

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4. Fig. 3. Proximal (a, b) and middle (c) parts of the body of the aneurysm. Disseminated perivascular lymphoid infiltrate. Distal part of the resected aortic wall (d). All images show a picture of destruction, mucoid edema of elastic fibers, smoothing of elastic membrane folds.

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