Reliability of non-contrast magnetic resonance angiography-derived aortic diameters in Marfan patients: comparison of inner vs. outer vessel wall measurements

Abstract

Aortic diameter measurements play a crucial role for the indication of aortic root surgery in Marfan patients. However, for magnetic resonance angiography (MRA)-derived measurements, there is no consensus on whether the aortic wall should be included or excluded in the aortic diameter. The purpose of this retrospective study was to compare the reliability of noncontrast bright blood MRA aortic inner-to-inner and outer-to-outer edge measurements in patients with Marfan syndrome. Forty Marfan patients underwent ECG-gated balanced steady-state free-precession MRA of the aorta at 1.5 T. Two readers independently performed inner and outer measurements at different aortic levels. They rated the image quality of the delineation of both inner and outer vessel wall edges on a four-point scale. MRA-derived diameters of the sinuses of Valsalva were compared with echocardiography-derived diameters. Aortic vessel wall delineation score was rated higher at all levels for inner than for outer vessel walls (p < 0.001). Inter-and intraobserver variances of aortic measurements were smaller for inner-to-inner measurements at the sinuses of Valsalva, sinotubular junction and ascending aorta (p < 0.03). There was a difference of 1.1 ± 2.3 mm for inner MRA measurements (p = 0.014) and 6.9 ± 3.1 mm for outer MRA measurements (p < 0.001) when compared to echocardiographic leading-edge measurements. Inner-to-inner vessel wall diameter measurements in non-contrast bright blood MRA provide more reliable diameters when compared to outer-to-outer vessel wall measurements of the aortic root. Therefore, we propose to rely on inner rather than outer aortic wall measurements in non-contrast-MRA when monitoring aortic diameters in patients with Marfan syndrome.

2D cine vs. 3D self-navigated free-breathing high-resolution whole heart cardiovascular magnetic resonance for aortic root measurements in congenital heart disease

“…The asymmetry was significantly more important in BAV patients than in non-BAV patients and associated to a larger discrepancy of CuCu diameters to TTE diameters (5.5 vs. 3.3 mm), similar to previous findings [21,26]. In contrast to TTE, CT and CMR show a very good agreement when determining I-I aortic root diameters as performed in our study [21,29,38].…”

“…Several studies compared nontriggered angiography with 2D cine or 3D bSSFP whole heart CMR, the latter usually ECG triggered and using a respiratory navigator [24,26,28]. For the 2D cine technique, a relatively large range of biases of 0.2 to 4 mm was reported for inter-and intra-observer variabilities [21,26,27,29]. Further studies compared 3D bSSFP whole heart sequences using respiratory navigators to either 3D ECG gated angiography or TTE [24,30,31].…”

“…The 3D self nav sequence used in this study offers a high spatial resolution with an isovolumetric voxel size of about 1.1 mm 3 in contrast to most studies using 2D or 3D Table 6 Comparison of aortic root diameters between echocardiography and cardiac magnetic resonance Of note, the decision on identification of three cusps did not match in 3 cases for observer 1 and in one case for observer 2. As patients without three identified cusps were allocated to the CuCu measurements and for two patients no TTE diameters were available, resulting TTE diameters in Table 6 differ slightly between analyses when using paired t-tests TTE transthoracic echocardiography, other see Tables 3 and 4 TTE vs. 2D cine bSSFP sequences and its acquisition duration is predictable [10,24,29,33]. The potential of the 3D self nav has been shown for imaging of coronary arteries, evaluation of anatomy in CHD and detection of myocardial scar [15,17,34].…”

2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines

“…5 Measuring from sinus-to-sinus and from inner-edge to inner-edge on CT and MRI has shown good correlation with TTE for measurements of the root and ascending segments, 6 as well as improved confidence in the delineation of aortic root margins on MRI and lower interobserver and interobserver variability. 7…”

Assessment of aortic diameter in Marfan patients: intraindividual comparison of 3D-Dixon and 2D-SSFP magnetic resonance imaging

“…Life-long annual aortic imaging is mandatory to determine the indication and timepoint of aortic root replacement in Marfan patients [3,10]. Elective surgery is indicated in the case of aortic root dilatation of ≥ 5 mm/year or an absolute aortic diameter of ≥ 50 mm [6,[11][12][13]. Accurate cross-sectional, and non-invasive radiation-free imaging techniques are needed for the life-long annual aortic imaging in Marfan patients.…”