Skip to main content
SpringerLink
Log in

MRT zur Therapiekontrolle bei Patienten mit Aortenisthmusstenose

MRI for therapy control in patients with aortic isthmus stenosis

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Die Aortenisthmusstenose als häufigste angeborene Aortenanomalie stellt ein häufiges Problem der Therapieüberwachung dar und ist neben möglichen begleitenden Anomalien (z. B. bikuspidale Aortenklappe) in Abhängigkeit vom primär gewählten Therapieverfahren mit verschiedenen Komplikationen im mittel- bis längerfristigem Verlauf vergesellschaftet. Bei der Kontrolle der Aortenisthmusstenose bzw. deren Therapie spielt die Magnetresonanztomographie (MRT) aufgrund der Nichtinvasivität und fehlenden Strahlenexposition bei den meist jüngeren Patienten eine wichtige Rolle. Der Radiologe sollte über die Grundzüge der Therapieverfahren informiert sein, um die MRT-Befunde kompetent zu befunden. Durch stetige Weiterentwicklungen der MRT-Technologie stehen neben der hochauflösenden MR-Angiographie (MRA) zunehmend auch Techniken der funktionellen Evaluierung (wie z. B. die dynamische MRA, 4D-PC-Flussmessungen) zur Verfügung, die u. U. auch das Risiko möglicher Komplikationen wie z. B. von Aneurysmen voraussagen könnten. Hierzu sind jedoch weitere Studien notwendig. Dabei wird v. a. zur Therapie möglicher Komplikationen nach einer Operation (Aneurysmen, Restenosen) die interventionelle Therapie mit Stents und Stentgrafts eingesetzt, wobei diese die Anwendung der MRT aufgrund häufiger massiver Metallartefakte z. T. deutlich limitiert.

Abstract

Aortic isthmus stenosis is the most common congenital aortic anomaly and is often a problem for therapy surveillance. In addition to possible comorbidities (e.g. bicuspid aortic valve) it is accompanied by various middle and long-term complications depending on the primary choice of the therapeutic procedure. Magnetic resonance imaging (MRI) plays an important role for the mostly young patients in the control of the aortic isthmus stenosis and therapy because it is non-invasive and there is no X-ray exposure. Radiologists should be well-informed on the principles of the therapeutic procedure in order to be competent in the interpretation of MRI findings. Due to the continuous development of MRI technology, techniques for functional evaluation (e.g. dynamic MRA, 4D PC flow measurement) are increasingly becoming available in addition to high-resolution MR angiography (MRA), which could predict the risk of possible complications, such as aneurysms. However, in this aspect further studies are necessary. Interventional therapy with stents and stent grafts is often employed for the therapy of possible complications following an operation (aneurysms, restenosis) but because of massive metal artefacts the use of MRI is often sometimes severely limited.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7

Literatur

  1. Attenberger UI, Michaely HJ, Wintersperger BJ et al (2008) Three-dimensional contrast-enhanced magnetic resonance angiography of the renal arteries: interindividual comparison of 0.2 mmol/kg gadobutrol at 1.5 T and 0.1 mmol/kg gadobenate dimeglumine at 3.0 T. Eur Radiol 18:1260–1268

    Article  PubMed  Google Scholar 

  2. Backer CL, Mavroudis C, Zias EA et al (1998) Repair of coarctation with resection and extended end-to-end anastomosis. Ann Thorac Surg 66:1365–1370; discussion 1370–1361

    Article  CAS  PubMed  Google Scholar 

  3. Barth MM, Smith MP, Pedrosa I et al (2007) Body MR imaging at 3.0 T: understanding the opportunities and challenges. Radiographics 27:1445–1462; discussion 1462–1444

    Article  PubMed  Google Scholar 

  4. Beaton AZ, Nguyen T, Lai WW et al (2009) Relation of coarctation of the aorta to the occurrence of ascending aortic dilation in children and young adults with bicuspid aortic valves. Am J Cardiol 103:266–270

    Article  PubMed  Google Scholar 

  5. Becker AE, Becker MJ, Edwards JE (1970) Anomalies associated with coarctation of aorta: particular reference to infancy. Circulation 41:1067–1075

    CAS  PubMed  Google Scholar 

  6. Bogaert J, Gewillig M, Rademakers F et al (1995) Transverse arch hypoplasia predisposes to aneurysm formation at the repair site after patch angioplasty for coarctation of the aorta. J Am Coll Cardiol 26:521–527

    Article  CAS  PubMed  Google Scholar 

  7. Bondy CA (2008) Aortic dissection in Turner syndrome. Curr Opin Cardiol 23:519–526

    Article  PubMed  Google Scholar 

  8. Campbell M (1970) Natural history of coarctation of the aorta. Br Heart J 32:633–640

    Article  CAS  PubMed  Google Scholar 

  9. Crafoord C (1980) Classics in thoracic surgery. Correction of aortic coarctation. Ann Thorac Surg 30:300–302

    Article  CAS  PubMed  Google Scholar 

  10. Deshpande VS, Shea SM, Li D (2003) Artifact reduction in true-FISP imaging of the coronary arteries by adjusting imaging frequency. Magn Reson Med 49:803–809

    Article  PubMed  Google Scholar 

  11. Eichhorn JG, Ley S (2007) Congenital abnormalities of the aorta in children and adolescents. Radiologe 47:974–981

    Article  CAS  PubMed  Google Scholar 

  12. Fawzy ME, Awad M, Hassan W et al (2004) Long-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults. J Am Coll Cardiol 43:1062–1067

    Article  PubMed  Google Scholar 

  13. Fixler DE, Pastor P, Chamberlin M et al (1990) Trends in congenital heart disease in Dallas County births. 1971–1984. Circulation 81:137–142

    CAS  PubMed  Google Scholar 

  14. Forbes TJ, Moore P, Pedra CA et al (2007) Intermediate follow-up following intravascular stenting for treatment of coarctation of the aorta. Catheter Cardiovasc Interv 70:569–577

    Article  PubMed  Google Scholar 

  15. Frydrychowicz A, Arnold R, Hirtler D et al (2008) Multidirectional flow analysis by cardiovascular magnetic resonance in aneurysm development following repair of aortic coarctation. J Cardiovasc Magn Reson 10:30

    Article  PubMed  Google Scholar 

  16. Gaca AM, Jaggers JJ, Dudley LT et al (2008) Repair of congenital heart disease: a primer – part 2. Radiology 248:44–60

    Article  PubMed  Google Scholar 

  17. Grech V (1999) Diagnostic and surgical trends, and epidemiology of coarctation of the aorta in a population-based study. Int J Cardiol 68:197–202

    Article  CAS  PubMed  Google Scholar 

  18. Gutberlet M, Noeske R, Schwinge K et al (2006) Comprehensive cardiac magnetic resonance imaging at 3.0 tesla: feasibility and implications for clinical applications. Invest Radiol 41:154–167

    Article  PubMed  Google Scholar 

  19. Hiratzka LF, Bakris GL, Beckman JA et al (2010) 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM 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 55:e27–e129

    Article  PubMed  Google Scholar 

  20. Ho VB, Bakalov VK, Cooley M et al (2004) Major vascular anomalies in Turner syndrome: prevalence and magnetic resonance angiographic features. Circulation 110:1694–1700

    Article  PubMed  Google Scholar 

  21. Hom JJ, Ordovas K, Reddy GP (2008) Velocity-encoded cine MR imaging in aortic coarctation: functional assessment of hemodynamic events. Radiographics 28:407–416

    Article  PubMed  Google Scholar 

  22. Hope MD, Meadows AK, Hope TA et al (2010) Clinical evaluation of aortic coarctation with 4D flow MR imaging. J Magn Reson Imaging 31:711–718

    Article  PubMed  Google Scholar 

  23. Julsrud PR, Breen JF, Felmlee JP et al (1997) Coarctation of the aorta: collateral flow assessment with phase-contrast MR angiography. AJR Am J Roentgenol 169:1735–1742

    CAS  PubMed  Google Scholar 

  24. 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 43:411–420

    Article  PubMed  Google Scholar 

  25. Krishnam MS, Tomasian A, Lohan DG et al (2008) Low-dose, time-resolved, contrast-enhanced 3D MR angiography in cardiac and vascular diseases: correlation to high spatial resolution 3D contrast-enhanced MRA. Clin Radiol 63:744–755

    Article  CAS  PubMed  Google Scholar 

  26. Krishnam MS, Tomasian A, Malik S et al (2010) Image quality and diagnostic accuracy of unenhanced SSFP MR angiography compared with conventional contrast-enhanced MR angiography for the assessment of thoracic aortic diseases. Eur Radiol 20:1311–1320

    Article  PubMed  Google Scholar 

  27. Litmanovich D, Bankier AA, Cantin L et al (2009) CT and MRI in diseases of the aorta. AJR Am J Roentgenol 193:928–940

    Article  PubMed  Google Scholar 

  28. Lock JE, Niemi T, Burke BA et al (1982) Transcutaneous angioplasty of experimental aortic coarctation. Circulation 66:1280–1286

    CAS  PubMed  Google Scholar 

  29. Lopez L, Arheart KL, Colan SD et al (2008) Turner syndrome is an independent risk factor for aortic dilation in the young. Pediatrics 121:e1622–e1627

    Article  PubMed  Google Scholar 

  30. Madore B, Henkelman RM (1994) Motion artifacts in fast spin-echo imaging. J Magn Reson Imaging 4:577–584

    Article  CAS  PubMed  Google Scholar 

  31. Oliver JM, Gallego P, Gonzalez A et al (2004) Risk factors for aortic complications in adults with coarctation of the aorta. J Am Coll Cardiol 44:1641–1647

    Article  PubMed  Google Scholar 

  32. Ou P, Celermajer DS, Mousseaux E et al (2007) Vascular remodeling after „successful“ repair of coarctation: impact of aortic arch geometry. J Am Coll Cardiol 49:883–890

    Article  PubMed  Google Scholar 

  33. Parks WJ, Ngo TD, Plauth WH Jr et al (1995) Incidence of aneurysm formation after dacron patch aortoplasty repair for coarctation of the aorta: long-term results and assessment utilizing magnetic resonance angiography with three-dimensional surface rendering. J Am Coll Cardiol 26:266–271

    Article  CAS  PubMed  Google Scholar 

  34. Presbitero P, Demarie D, Villani M et al (1987) Long term results (15–30 years) of surgical repair of aortic coarctation. Br Heart J 57:462–467

    Article  CAS  PubMed  Google Scholar 

  35. Rodes-Cabau J, Miro J, Dancea A et al (2007) Comparison of surgical and transcatheter treatment for native coarctation of the aorta in patients > or 1 year old. The Quebec Native Coarctation of the Aorta Study. Am Heart J 154:186–192

    Article  PubMed  Google Scholar 

  36. Seng K, Maderwald S, De Greiff A et al (2010) Dynamic contrast-enhanced magnetic resonance angiography of the thoracic vessels: an intraindividual comparison of different k-space acquisition strategies. Invest Radiol, in press

  37. Smith DE, Matthews MB (1955) Aortic valvular stenosis with coarctation of the aorta, with special reference to the development of aortic stenosis upon congenital bicuspid valves. Br Heart J 17:198–206

    Article  CAS  PubMed  Google Scholar 

  38. Song T, Laine AF, Chen Q et al (2009) Optimal k-space sampling for dynamic contrast-enhanced MRI with an application to MR renography. Magn Reson Med 61:1242–1248

    Article  PubMed  Google Scholar 

  39. Tanous D, Benson LN, Horlick EM (2009) Coarctation of the aorta: evaluation and management. Curr Opin Cardiol 24:509–515

    Article  PubMed  Google Scholar 

  40. Theisen D, Wintersperger BJ, Huber A et al (2007) Myocardial perfusion imaging with gadobutrol: a comparison between 3 and 1.5 tesla with an identical sequence design. Invest Radiol 42:499–506

    Article  CAS  PubMed  Google Scholar 

  41. Tzemos N, Therrien J, Yip J et al (2008) Outcomes in adults with bicuspid aortic valves. JAMA 300:1317–1325

    Article  CAS  PubMed  Google Scholar 

  42. Voges I, Jerosch-Herold M, Helle M et al (2010) 3 Tesla magnetic resonance imaging in children and adults with congenital heart disease. Radiologe, in press

  43. Von Kodolitsch Y, Aydin MA, Koschyk DH et al (2002) Predictors of aneurysmal formation after surgical correction of aortic coarctation. J Am Coll Cardiol 39:617–624

    Article  Google Scholar 

  44. Vossschulte K (1957) Plastic surgery of the isthmus in aortic isthmus stenosis. Thoraxchirurgie 4:443–450

    CAS  PubMed  Google Scholar 

  45. Waldhausen JA, Nahrwold DL (1966) Repair of coarctation of the aorta with a subclavian flap. J Thorac Cardiovasc Surg 51:532–533

    CAS  PubMed  Google Scholar 

  46. Warnes CA, Fuster V, Mcgoon DC (1996) Coarctation of the aorta. Mayo clinic practice of cardiology. Mosby, St. Louis, pp 1572–1580

  47. Wintersperger BJ, Bauner K, Reeder SB et al (2006) Cardiac steady-state free precession CINE magnetic resonance imaging at 3.0 tesla: impact of parallel imaging acceleration on volumetric accuracy and signal parameters. Invest Radiol 41:141–147

    Article  PubMed  Google Scholar 

  48. Wintersperger BJ, Sincleair S, Runge VM et al (2007) Dual breath-hold magnetic resonance cine evaluation of global and regional cardiac function. Eur Radiol 17:73–80

    Article  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, München, Deutschland

    B.J. Wintersperger MD, D. Theisen & M.F. Reiser

  2. Department of Medical Imaging, University Health Network, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto M5G 2N2, Canada

    B.J. Wintersperger MD

Authors
  1. B.J. Wintersperger MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Theisen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M.F. Reiser
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B.J. Wintersperger MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wintersperger, B., Theisen, D. & Reiser, M. MRT zur Therapiekontrolle bei Patienten mit Aortenisthmusstenose. Radiologe 51, 23–30 (2011). https://doi.org/10.1007/s00117-010-1997-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-010-1997-6

Schlüsselwörter

Keywords

Search

Navigation