, Volume 14, Issue 2, pp 143–157 | Cite as

Aktuelle Bildgebung der Aorta

  • H. von Tengg-KobligkEmail author
  • T.F. Weber
  • S. Ley
  • V. Hankel
  • F. Rengier
  • D. Kotelis
  • D. Böckler
  • H.-U. Kauczor
CME Weiterbildung • Zertifizierte Fortbildung


Die aktuelle Bildgebung der Aorta hat in den letzten Jahren an Vielfalt und Qualität gewonnen. Neben der Verifizierung und Dokumentation einer klinischen Verdachtsdiagnose stellt sie die Grundlage für die Indikationsstellung, die Wahl des Therapieverfahrens (konservativ, operativ, interventionell), die Therapieplanung und die Nachsorge dar. Neben der B-Mode- und der Duplexsonographie sowie der transösophagealen Echokardiographie (TEE) spielen heute v. a. die kontrastmittelunterstützten Schnittbildverfahren, die Computertomographie (CT) mit der Option zur CT-Angiographie (CTA) und die Magnetresonanztomographie (MRT) mit der Option der MR-Angiographie (MRA) eine wesentliche Rolle. Der folgende Beitrag beschreibt aus Sicht des Radiologen in einer Klinik der Maximalversorgung die Möglichkeiten der CTA und MRA für die Abklärung aortaler Pathologien.


Aorta Aortale Pathologien Computertomographie Angiographie Magnetresonanztomographie 

State-of-the-art aortic imaging


Current imaging of the aorta saw an improvement in terms of diversity and quality in recent years. In addition to verifying and documenting a clinical suspicion, it provides the basis for establishing an indication, choosing a therapy (conservative, surgical, interventional), as well as therapy planning and follow-up. Besides B-mode and duplex sonography, as well as transesophageal echocardiography (TEE), contrast-enhanced cross-sectional imaging, computer tomography (CT), with the option for CT angiography (CTA), and magnetic resonance tomography (MRT), with the option for MR angiography (MRA), play a significant role. The present article describes the possibilities offered by CTA and MRA for the diagnosis of aortic pathologies from the point of view of the radiologist in a maximum care hospital.


Aorta Aortic pathologies Computed tomography Angiography Magnetic resonance tomography 



Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.


  1. 1.
    Alvarez B, Constenla I, Maeso J, Matas M (2009) Late thrombosis of a thoracic aorta stent graft: therapeutic management. J Vasc Surg Jan 13. [Epub ahead of print]Google Scholar
  2. 2.
    Ashton HA, Buxton MJ, Day NE et al (2002) The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial. Lancet 360:1531–1539PubMedCrossRefGoogle Scholar
  3. 3.
    Bendick PJ, Zelenock GB, Bove PG et al (2003) Duplex ultrasound imaging with an ultrasound contrast agent: the economic alternative to CT angiography for aortic stent graft surveillance. Vasc Endovascular Surg 37:165–170PubMedCrossRefGoogle Scholar
  4. 4.
    Bireley WR, Diniz LO, Groves EM et al (2007) Orthogonal measurement of thoracic aorta luminal diameter using ECG-gated high-resolution contrast-enhanced MR angiography. J Magn Reson Imaging 26:1480–1485PubMedCrossRefGoogle Scholar
  5. 5.
    Böckler D, Allenberg JR, Kauczor HU, Tengg-Kobligk H von (2005) Images in vascular medicine. Postprocessing ‚fly-through‘ of multislice computed tomography after thoracic endografting. Vasc Med 10:61–62PubMedCrossRefGoogle Scholar
  6. 6.
    Böckler D, Tengg-Kobligk H von, Schumacher H et al (2005) Late surgical conversion after thoracic endograft failure due to fracture of the longitudinal support wire. J Endovasc Ther 12:98–102PubMedCrossRefGoogle Scholar
  7. 7.
    Böckler D, Hylik-Durr A, Tengg-Kobligk H von et al (2007) Clinical requirements of aortic imaging. Radiologe 47:962–973PubMedCrossRefGoogle Scholar
  8. 8.
    Böckler D, Kotelis D, Kohlhof P et al (2007) Spinal cord ischemia after endovascular repair of the descending thoracic aorta in a sheep model. Eur J Vasc Endovasc Surg 34:461–469PubMedCrossRefGoogle Scholar
  9. 9.
    Carr JC, Finn JP (2003) MR imaging of the thoracic aorta. Magn Reson Imaging Clin N Am 11:135–148PubMedCrossRefGoogle Scholar
  10. 10.
    Chandarana H, Godoy MC, Vlahos I et al (2008) Abdominal aorta: evaluation with dual-source dual-energy multidetector CT after endovascular repair of aneurysms – initial observations. Radiology 249:692–700PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen EI, Weinreb DB, Siegelbaum RH et al (2008) Time-resolved MR angiography for the classification of endoleaks after endovascular aneurysm repair. J Magn Reson Imaging 27:500–503PubMedCrossRefGoogle Scholar
  12. 12.
    Czum JM, Corse WR, Ho VB (2005) MR angiography of the thoracic aorta. Magn Reson Imaging Clin N Am 13:41–64 PubMedCrossRefGoogle Scholar
  13. 13.
    Fink C, Ley S, Kroeker R et al (2005) Time-resolved contrast-enhanced three-dimensional magnetic resonance angiography of the chest: combination of parallel imaging with view sharing (TREAT). Invest Radiol 40:40–48PubMedCrossRefGoogle Scholar
  14. 14.
    Francois CJ, Tuite D, Deshpande V et al (2008) Unenhanced MR angiography of the thoracic aorta: initial clinical evaluation. AJR Am J Roentgenol 190:902–906PubMedCrossRefGoogle Scholar
  15. 15.
    Frauenfelder T, Boutsianis E, Alkadhi H et al (2007) Simulation of blood flow within the abdominal aorta. Computational fluid dynamics in abdominal aortic aneurysms before and after interventions. Radiologe 47:1021–1028PubMedCrossRefGoogle Scholar
  16. 16.
    Frauenfelder T, Appenzeller P, Karlo C et al (2008) Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings. Eur Radiol Nov 18. [Epub ahead of print]Google Scholar
  17. 17.
    Frydrychowicz A, Markl M, Harloff A et al (2007) Flow-sensitive in-vivo 4D MR imaging at 3T for the analysis of aortic hemodynamics and derived vessel wall parameters. Rofo 179:463–472PubMedGoogle Scholar
  18. 18.
    Ganten MK, Weber TF, Tengg-Kobligk H von et al (2008) Motion characterization of aortic wall and intimal flap by ECG-gated CT in patients with chronic B-dissection. Eur J Radiol Aug 2. [Epub ahead of print]Google Scholar
  19. 19.
    Goel VR, Greenberg RK, Greenberg DP (2008) Automated vascular geometric analysis of aortic aneurysms. IEEE Comput Graph Appl 28:76–86PubMedCrossRefGoogle Scholar
  20. 20.
    Gopal A, Mao SS, Karlsberg D et al (2008) Radiation reduction with prospective ECG-triggering acquisition using 64-multidetector computed tomographic angiography. Int J Cardiovasc Imaging Dec 3. [Epub ahead of print]Google Scholar
  21. 21.
    Greenberg RK, Turc A, Haulon S et al (2004) Stent-graft migration: a reappraisal of analysis methods and proposed revised definition. J Endovasc Ther 11:353–363PubMedCrossRefGoogle Scholar
  22. 22.
    Groves EM, Bireley W, Dill K et al (2007) Quantitative analysis of ECG-gated high-resolution contrast-enhanced MR angiography of the thoracic aorta. AJR Am J Roentgenol 188:522–528PubMedCrossRefGoogle Scholar
  23. 23.
    Heye T, Karck M, Richter G, Hosch W (2007) Visualization of entry and re-entry tears in a complex type A aortic dissection by 64-slice dual-source computer tomography. Eur J Cardiothorac Surg 32:935PubMedGoogle Scholar
  24. 24.
    Heyer KS, Modi P, Morasch MD et al (2009) Secondary infections of thoracic and abdominal aortic endografts. J Vasc Interv Radiol 20:173–179PubMedCrossRefGoogle Scholar
  25. 25.
    Iezzi R, Cotroneo AR, Filippone A et al (2006) Multidetector CT in abdominal aortic aneurysm treated with endovascular repair: are unenhanced and delayed phase enhanced images effective for endoleak detection? Radiology 241:915–921PubMedCrossRefGoogle Scholar
  26. 26.
    Iezzi R, Basilico R, Giancristofaro D et al (2009) Contrast-enhanced ultrasound versus color duplex ultrasound imaging in the follow-up of patients after endovascular abdominal aortic aneurysm repair. J Vasc Surg Jan 8. [Epub ahead of print]Google Scholar
  27. 27.
    Johnson TR, Nikolaou K, Becker A et al (2008) Dual-source CT for chest pain assessment. Eur Radiol 18:773–780PubMedCrossRefGoogle Scholar
  28. 28.
    Kabul HK, Hagspiel KD (2006) Cross-sectional vascular imaging with CT and MR angiography. J Nucl Cardiol 13:385–401PubMedCrossRefGoogle Scholar
  29. 29.
    Kluge A, Gerriets T, Muller C et al (2005) Thoracic real-time MRI: experience from 2200 examinations in acute and ill-defined thoracic diseases. Rofo 177:1513–1521PubMedGoogle Scholar
  30. 30.
    Kotelis D, Geisbusch P, Tengg-Kobligk H von et al (2008) Paraplegia after endovascular repair of the thoracic and thoracoabdominal aorta. Zentralbl Chir 133:338–343PubMedCrossRefGoogle Scholar
  31. 31.
    Kotelis D, Lopez-Benitez R, Tengg-Kobligk H et al (2008) Endovascular repair of stent graft collapse by stent-protected angioplasty using a femoral-brachial guidewire. J Vasc Surg 48:1609–1612PubMedCrossRefGoogle Scholar
  32. 32.
    Krishnam MS, Tomasian A, Deshpande V et al (2008) Noncontrast 3D steady-state free-precession magnetic resonance angiography of the whole chest using nonselective radiofrequency excitation over a large field of view: comparison with single-phase 3D contrast-enhanced magnetic resonance angiography. Invest Radiol 43:411–420PubMedCrossRefGoogle Scholar
  33. 33.
    Kunz RP, Oberholzer K, Kuroczynski W et al (2004) Assessment of chronic aortic dissection: contribution of different ECG-gated breath-hold MRI techniques. AJR Am J Roentgenol 182:1319–1326PubMedGoogle Scholar
  34. 34.
    Lell MM, Anders K, Uder M et al (2006) New techniques in CT angiography. Radiographics [Suppl 1] 26:S45–S62Google Scholar
  35. 35.
    Ley-Zaporozhan J, Kreitner KF, Unterhinninghofen R et al (2008) Assessment of thoracic aortic dimensions in an experimental setting: comparison of different unenhanced magnetic resonance angiography techniques with electrocardiogram-gated computed tomography angiography for possible application in the pediatric population. Invest Radiol 43:179–186PubMedCrossRefGoogle Scholar
  36. 36.
    Lohan DG, Krishnam M, Saleh R et al (2008) MR imaging of the thoracic aorta. Magn Reson Imaging Clin N Am 16:213–234PubMedCrossRefGoogle Scholar
  37. 37.
    Merkle EM, Klein S, Wisianowsky C et al (2002) Magnetic resonance imaging versus multislice computed tomography of thoracic aortic endografts. J Endovasc Ther [Suppl 2] 9:112–113Google Scholar
  38. 38.
    Mohrs OK, Petersen SE, Voigtlaender T et al (2006) Time-resolved contrast-enhanced MR angiography of the thorax in adults with congenital heart disease. AJR Am J Roentgenol 187:1107–1114PubMedCrossRefGoogle Scholar
  39. 39.
    Morales JP, Greenberg RK, Lu Q et al (2008) Endoleaks following endovascular repair of thoracic aortic aneurysm: etiology and outcomes. J Endovasc Ther 15:631–638PubMedCrossRefGoogle Scholar
  40. 40.
    Mory M, Allenberg JR, Schumacher H et al (2008) Open decompression, proximal banding and aneurysm sac fenestration as an alternative to conversion in the management of endotension after EVAR. J Endovasc Ther 15:449–452PubMedCrossRefGoogle Scholar
  41. 41.
    Pannu HK, Alvarez W Jr, Fishman EK (2006) Beta-blockers for cardiac CT: a primer for the radiologist. AJR Am J Roentgenol 186:S341–S345PubMedCrossRefGoogle Scholar
  42. 42.
    Petersilka M, Bruder H, Krauss B et al (2008) Technical principles of dual source CT. Eur J Radiol 68:362–368PubMedCrossRefGoogle Scholar
  43. 43.
    Raman KG, Missig-Carroll N, Richardson T et al (2003) Color-flow duplex ultrasound scan versus computed tomographic scan in the surveillance of endovascular aneurysm repair. J Vasc Surg 38:645–651PubMedCrossRefGoogle Scholar
  44. 44.
    Rengier F, Weber T, Giesel F et al (2009) Centerline analysis of CT angiographies: benefits and limitations. Am J Roentgenol (in press)Google Scholar
  45. 45.
    Roos JE, Hellinger JC, Hallet R et al (2005) Detection of endograft fractures with multidetector row computed tomography. J Vasc Surg 42:1002–1006PubMedCrossRefGoogle Scholar
  46. 46.
    Sakamoto I, Sueyoshi E, Uetani M (2007) MR imaging of the aorta. Radiol Clin North Am 45:485–497 PubMedCrossRefGoogle Scholar
  47. 47.
    Schneider G, Massmann A, Altmeyer K et al (2007) MR imaging and MR angiography of the aorta. Radiologe 47:993–1002PubMedCrossRefGoogle Scholar
  48. 48.
    Schumacher H, Böckler D, Kotelis D et al (2008) Neue Wege in der Behandlung von Aortenerkrankungen: Computerunterstützte Patientenselektion, Therapieplanung und Nachsorge. Chir Allgemeine 6:279–289Google Scholar
  49. 49.
    Shapiro MD, Pena AJ, Nichols JH et al (2008) Efficacy of pre-scan beta-blockade and impact of heart rate on image quality in patients undergoing coronary multidetector computed tomography angiography. Eur J Radiol 66:37–41PubMedCrossRefGoogle Scholar
  50. 50.
    Stavropoulos SW, Charagundla SR (2007) Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Radiology 243:641–655PubMedCrossRefGoogle Scholar
  51. 51.
    Stolzmann P, Frauenfelder T, Pfammatter T et al (2008) Endoleaks after endovascular abdominal aortic aneurysm repair: detection with dual-energy dual-source CT. Radiology 249:682–691PubMedCrossRefGoogle Scholar
  52. 52.
    Szucs-Farkas Z, Kurmann L, Strautz T et al (2008) Patient exposure and image quality of low-dose pulmonary computed tomography angiography: comparison of 100- and 80-kVp protocols. Invest Radiol 43:871–876PubMedCrossRefGoogle Scholar
  53. 53.
    Tengg-Kobligk H von, Böckler D, Jose TM et al (2007) Feeding arteries of the spinal cord at CT angiography before and after thoracic aortic endografting. J Endovasc Ther 14:639–649CrossRefGoogle Scholar
  54. 54.
    Tengg-Kobligk H von, Weber TF, Rengier F et al (2007) Aktuelle Bildnachverarbeitung der aortalen CTA und MRA. Radiologe 47:1003–1011CrossRefGoogle Scholar
  55. 55.
    Tengg-Kobligk H von, Weber TF, Rengier F et al (2008) Imaging modalities for the thoracic aorta. J Cardiovasc Surg (Torino) 49:429–447Google Scholar
  56. 56.
    Tengg-Kobligk H von, Ley-Zaporozhan J, Henninger V et al (2009) Intraindividueller Vergleich zwischen nativer und kontrastverstärkter MR-Angiografie der thorakalen Aorta. Fortschr Röntgenstr in pressGoogle Scholar
  57. 57.
    Theisen D, Tengg-Kobligk H von, Michaely H et al (2007) CT angiography of the aorta. Radiologe 47:982–992PubMedCrossRefGoogle Scholar
  58. 58.
    Unterhinninghofen R, Ley S, Ley-Zaporozhan J et al (2008) Concepts for visualization of multidirectional phase-contrast MRI of the heart and large thoracic vessels. Acad Radiol 15:361–369PubMedCrossRefGoogle Scholar
  59. 59.
    Van der Laan MJ, Bakker CJ, Blankensteijn JD, Bartels LW (2006) Dynamic CE-MRA for endoleak classification after endovascular aneurysm repair. Eur J Vasc Endovasc Surg 31:130–135CrossRefGoogle Scholar
  60. 60.
    Van der Laan MJ, Bartels LW, Viergever MA, Blankensteijn JD (2006) Computed tomography versus magnetic resonance imaging of endoleaks after EVAR. Eur J Vasc Endovasc Surg 32:361–365CrossRefGoogle Scholar
  61. 61.
    Van Herwaarden JA, Muhs BE, Vincken KL et al (2006) Aortic compliance following EVAR and the influence of different endografts: determination using dynamic MRA. J Endovasc Ther 13:406–414CrossRefGoogle Scholar
  62. 62.
    Watanabe Y, Uotani K, Nakazawa T et al (2008) Dual-energy direct bone removal CT angiography for evaluation of intracranial aneurysm or stenosis: comparison with conventional digital subtraction angiography. Eur Radiol Nov 11. [Epub ahead of print]Google Scholar
  63. 63.
    Weber TF, Ganten MK, Böckler D et al (2008) Heartbeat-related displacement of the thoracic aorta in patients with chronic aortic dissection type B: Quantification by dynamic CTA. Eur J Radiol Sep 19. [Epub ahead of print]Google Scholar
  64. 64.
    Weber TF, Ganten MK, Böckler D et al (2008) Assessment of thoracic aortic conformational changes by four-dimensional computed tomography angiography in patients with chronic aortic dissection type b. Eur Radiol 19:245–253 PubMedCrossRefGoogle Scholar
  65. 65.
    Willicombe M, Cunningham J (2008) Nephrogenic systemic fibrosis: a sufficient reason to avoid gadolinium-based contrast in all patients with renal impairment? Semin Dial 21:140–141PubMedCrossRefGoogle Scholar
  66. 66.
    Wintersperger B, Jakobs T, Herzog P et al (2005) Aorto-iliac multidetector-row CT angiography with low kV settings: improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol 15:334–341PubMedCrossRefGoogle Scholar
  67. 67.
    Yu T, Zhu X, Tang L et al (2007) Review of CT angiography of aorta. Radiol Clin North Am 45:461–483PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag 2009

Authors and Affiliations

  • H. von Tengg-Kobligk
    • 1
    Email author
  • T.F. Weber
    • 2
  • S. Ley
    • 2
  • V. Hankel
    • 1
  • F. Rengier
    • 1
    • 2
  • D. Kotelis
    • 3
  • D. Böckler
    • 3
  • H.-U. Kauczor
    • 2
  1. 1.Radiologie – E010Deutsches Krebsforschungszentrum (DKFZ)HeidelbergDeutschland
  2. 2.Diagnostische und Interventionelle RadiologieUniversitätsklinikum HeidelbergHeidelbergDeutschland
  3. 3.Klinik für Gefäßchirurgie, Vaskuläre und Endovaskuläre ChirurgieChirurgische Universitätsklinik HeidelbergHeidelbergDeutschland

Personalised recommendations