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(Circulation. 1998;98:509-518.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Evaluation of the Aortic Root by MRI

Insights From Patients With Homozygous Familial Hypercholesterolemia

Ronald M. Summers, MD, PhD; Jonathan Andrasko-Bourgeois, BA; Irwin M. Feuerstein, MD; Suvimol C. Hill, MD; Elizabeth C. Jones, MD; Mary K. Busse, BSEd, RT(R)(MR); Betty Wise, RT(R)(MR); Karen E. Bove, RT(R)(MR); Beth A. Rishforth, RN, BSN; Eben Tucker, MD; Thomas L. Spray, MD; ; Jeffrey M. Hoeg, MD

From the Diagnostic Radiology Department, Warren Grant Magnuson Clinical Center, National Institutes of Health (R.M.S., J.A.-B., I.M.F., S.C.H., E.C.J., M.K.B., B.W., K.E.B.), and the National Heart, Lung, and Blood Institute (B.A.R., E.T., J.M.H.), Bethesda, Md; and Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine (T.L.S.).

Correspondence to Ronald M. Summers, MD, PhD, Diagnostic Radiology Department, Bldg 10, Room 1C660, 10 Center Dr, MSC 1182, Bethesda, MD 20892-1182. E-mail rms{at}nih.gov

Background—In homozygous familial hypercholesterolemia (HFH), the aortic root is prone to develop atherosclerotic plaque at an early age. However, the aortic wall and plaque have not yet been assessed in this condition by MRI. We evaluated the aortic root by use of MRI in 17 HFH patients and 12 normal control subjects in a prospective, blinded, controlled study.

Methods and Results—Morphological assessment of the aortic root was done with spin-echo and gradient-echo MRI scanning. Comparisons were made with a number of measures of disease severity, including cholesterol-year score, calcium score on electron-beam CT (EBCT), and size of Achilles tendon xanthomas. Atherosclerotic plaque, visible on fat-suppressed images but never on water-suppressed images, was present in 9 HFH patients (53%). Supravalvular aortic stenosis was present in 7 patients with HFH (41%). Maximum supravalvular aortic wall thickness was significantly greater and OD and lumen cross-sectional area (CSA) were smaller in patients than in control subjects (P=0.006, 0.0005, and 0.06, respectively). Maximum wall thickness was associated with a greater calcium score on electron-beam CT (P=0.02). Although the cumulative exposure of the aortic root to cholesterol (the cholesterol-year score) was significantly correlated with the Achilles tendon CSA and vascular calcification, this score did not correlate with the wall thickness or aortic CSA.

Conclusions—This study not only demonstrates the utility of MRI for detecting and characterizing aortic root atherosclerotic plaque and supravalvular aortic stenosis in HFH patients but also suggests that the LDL receptor plays a direct or indirect role in aortic mural development and vascular growth.

Key Words: atherosclerosis • magnetic resonance imaging • vasculature • cholesterol • aorta

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