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(Circulation. 2004;109:e42-e43.)
© 2004 American Heart Association, Inc.

Images in Cardiovascular Medicine

Pseudoaneurysms of the Ascending Aorta Demonstrated With "Motion-Free" Multislice Computed Tomography

Filippo Cademartiri, MD; Koen Nieman, MD; Nico Mollet, MD; Pim J. de Feyter, MD, PhD; Gabriel P. Krestin, MD, PhD

From the Department of Radiology (F.C., K.N., N.M., P.J.d.F., G.P.K.) and the Department of Cardiology, Thoraxcentrum (K.N., N.M., P.J.d.F.), Erasmus Medical Center, Rotterdam, The Netherlands.

Correspondence and reprint requests to Filippo Cademartiri, MD, Department of Radiology, Erasmus Medical Center, Dr Molenwaterplein, 40, 3015 GD, Rotterdam, The Netherlands. E-mail filippocademartiri{at}hotmail.com

The main challenge of noninvasive vascular imaging of the heart and thorax is the reduction of motion artifacts derived from respiration and heartbeat. Respiratory motion can be suppressed performing the scan during breath hold. Cardiac motion needs a very fast scan time in order to be suppressed.

A 54-year-old man was referred to our hospital for acute chest pain and suspected dissection of the thoracic aorta. A contrast-enhanced 4-row multislice computed tomography (MSCT) angiography (volume zoom, Siemens Medical Solutions, Forchheim, Germany) demonstrated a type A dissection (Figure 1). At surgery, a graft was positioned at the level of aortic valve and another one at the level of the ascending aorta. After 8 months, the patient underwent contrast- enhanced 16-row MSCT angiography (sensation 16, Siemens Medical Solutions, Forchheim, Germany) with retrospective ECG gating to reduce motion artifacts from heartbeat (Figures 2 and 3).

View larger version (169K): [in this window] [in a new window]   Figure 1. Contrast-enhanced 4-row MSCT at patient’s presentation. In a scan performed during the very early arterial phase (Early arterial panel), contrast material is only inside the true lumen of the dissection (arrow), whereas the false lumen is still unenhanced (*). In a later phase (Late arterial panel), the true lumen (arrow) and false lumen (*) are both perfused by contrast material.

View larger version (169K): [in this window] [in a new window]   Figure 2. Follow-up contrast-enhanced 16-row MSCT. Axial slices performed at the level of the caudal (A) and cranial (B) ends of the graft in the ascending aorta (Ao) demonstrate 3 pseudoaneurysms. A very small pseudoaneurysm (A and E, arrowheads) is located on the left anterolateral wall of the ascending aorta, at the caudal end. A bigger one (A and D, thin arrow) is located on the anterior wall of the ascending aorta, at the caudal end. A third, large one (B and C, thick arrow) is located on the anterior wall of the ascending aorta, at the cranial end.

View larger version (91K): [in this window] [in a new window]   Figure 3. Three-dimensional volume rendering of the follow-up 16-row MSCT scan. A panoramic view of the thorax is displayed in panel A after segmentation of the anterior thoracic wall. Configuration of the grafted ascending aorta (Ao) is nicely depicted as well as the right coronary artery (RCA). After segmentation of bones and pulmonary vessels, only the heart and the thoracic aorta are left for visualization (B and C). Location and configuration of the 3 pseudoaneurysms are displayed (arrowhead for the small caudal one, thin arrow for the bigger caudal one, and thick arrow for the large cranial one; panel C). RV indicates right ventricle; LV, left ventricle.

Three pseudoaneurysms are clearly demonstrated in both the axial and the multiplanar reconstructions (Figure 2), as well as with 3-dimensional volume rendering (Figure 3, Movies I and II). Two small pseudoaneurysms are located anteriorly at the root of the ascending aorta (Figures 2D and 2E), and a larger one is located anteriorly but at the level of the junction of the ascending aorta and aortic arch before the origin of the right brachiocephalic trunk (Movie III).

Motion artifacts are completely suppressed, and image quality is high also in the visualization of coronary arteries.

Footnotes

Movies are available in the online-only Data Supplement at http://www.circulationaha.org.

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

This Article Full Text (PDF) Data Supplement Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cademartiri, F. Articles by Krestin, G. P. Search for Related Content PubMed PubMed Citation Articles by Cademartiri, F. Articles by Krestin, G. P. Pubmed/NCBI databases Medline Plus Health Information CT Scans Related Collections Imaging Other etiology CT and MRI