Use of 4D flow MRI as a predictor of non complicated type B aortic dissection expansion: A case report

Presenting Author(s)

• 

  Cecilia Matheus, MD

  Cardioimaging fellow
  CT Scanner
  Ciudad de Mexico, Distrito Federal, Mexico

Primary Author(s)

• 

  Cecilia Matheus, MD

  Cardioimaging fellow
  CT Scanner
  Ciudad de Mexico, Distrito Federal, Mexico

Co-Author(s)

• UT

  Uriel Alberto Tarin-Gomez, MD

  Cardioimaging fellow
  CT Scanner, Chihuahua, Mexico
• AG

  Angel Garrido-Urincho, MD

  Cardioimaging fellow
  CT Scanner, Distrito Federal, Mexico
• MM

  Manuel Mendicuti-Paat, MD

  Cardioimaging fellow
  CT Scanner, Distrito Federal, Mexico
• 

  Laura Victoria Torres-Araujo, MD, FSCMR

  Consultant
  CT Scanner - Instituto Nacional de Cardiología "Ignacio Chávez"
  Mexico , Mexico City, Mexico
• MJ

  Moises Jimenez, MD

  CT and CMR Consultant
  CT Scanner Lomas Altas
  Ciudad de Mexico, Distrito Federal, Mexico
• AR

  Ana Rosas, MD

  CMR and CT consultant
  CT Scanner Lomas Altas
  Mexico city, Distrito Federal, Mexico
• 

  Jorge A. Silva Estrada, MD

  Consultant cardiovascular imaging
  CT Scanner; Instituto Nacional de Pediatria (CMDX)
  Mexico City, Distrito Federal, Mexico
• LZ

  Liliana Zarco-Garcia, MD

  Cardiovascular imaging CT scanner Mexico
  CT Scanner, Distrito Federal, Mexico
• LS

  Luz Dinora Sandoval, MD

  CMR and CT Consultant
  CT Scanner
  Ciudad de Me, Distrito Federal, Mexico

Description of Clinical Presentation: We present the case of a 58-year-old male patient, without comorbidities, diagnosed with Stanford B, De Bakey III aortic dissection since 2016 by contrast enhanced computed tomography, who came to follow-up CT study, currently asymptomatic.

Diagnostic Techniques and Their Most Important Findings: A contrast-enhanced CT angiography of the thorax and abdomen was performed, identifying a complex dissection flap that begins at the level of the medial wall of the descending aorta at T7 level, with caudal extension to the proximal right external iliac artery. This dissection flap has a spiral morphology with the false lumen arranged in the right lateral wall at the thoracic level, posterior arrangement at the infrarenal level and lateral in the right iliac artery (Panel A and B).

After performing the CT images a cardiac magnetic resonance with additional 4D Flow sequences was performed. The maximum wall energy loss from entry tear to distal descending thoracic aorta was 1.8mW (C), false lumen regurgitation was 0% (D - green arrow) with a systolic peak velocity < 1m/s (D-yellow arrow), the true lumen dynamics was also analyzed with a peak systolic velocity below 1m/s (D-red arrow), all of them previously noticed as potential low probability progression markers (< 3mm/year).

Learning Points from this Case: There is no imaging method that can predict the results in uncomplicated aortic dissection (Stanford B); but in our specific case, the asymptomatic and stable condition of our patient correlate with the hemodynamic parameters found in the 4D-flow CMR analysis, highlighting the previously published results and the potential impact of 4D-flow magnetic resonance imaging in aortic disease.

A.- Curve reconstruction of dissection. B.- Axial plane showing real and false lumen. C.- MIP with max. energy loss. D.- 4D flow showing true and false lumen blood flow.