Aortic Diseases

Abstract

Aortic diseases encompass a wide of range of pathologies, which can involve heart chambers and valves and can extend to vascular branches, besides affecting the aortic wall. Cardiac magnetic resonance (CMR) has emerged as a multiparametric diagnostic tool which allows the assessment of complex disease within a single examination. Vessel course, patency, and connections, together with vessel wall, plaque characteristics, intimal flaps, and intramural haemorrhage can be visualized thanks to specific functional (SSFP cines, fast gradient echo and velocity encoding sequences) and morphologic sequences (fast spin echo sequences). Aortic wall inflammation can be assessed with STIR T2-weighted images and late gadolinium enhancement. Contrast-enhanced magnetic resonance angiography (CE-MRA) allows the acquisition of isotropic 3D datasets with high space resolution that can be reconstructed in any plane and is the ideal tool to assess aortic anatomy and dimensions and characterize pathology like aneurysms, dissection, atherosclerotic plaque, and thrombus, while assessing the presence or extension of pathology to main aortic branches. Moreover, in the same examination cardiac chambers dimensions, function and heart muscle tissue characterization can be achieved, together with detailed morphologic and functional evaluation of heart valves. In this chapter, an introduction to the applications of CMR in the study of aortic disease is presented and is followed by the description of ten clinical cases. These cases highlight the role of CMR and CE-MRA in the diagnostic workflow of aortic pathology, as well as in decision-making process and disease follow-up. Moreover, the cases emphasize the relevance of an integrated advanced cardiac imaging approach in the management of aortic pathology and the key role of knowledge of patients’ global clinical frame in aortic disease, as the aorta can be a target of systemic connective or rheumatologic pathology.