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

TY - JOUR

T1 - Reliability of non-contrast magnetic resonance angiography-derived aortic diameters in Marfan patients: comparison of inner vs. outer vessel wall measurements

AU - Weinrich, Julius Matthias

AU - Avanesov, Maxim

AU - Lenz, Alexander

AU - Tahir, Enver

AU - Henes, Frank-Oliver

AU - Schoennagel, Bjoern Philip

AU - Rybczynski, Meike

AU - Adam, Gerhard

AU - Kodolitsch, Yskert

AU - Bannas, Peter

PY - 2020/8

Y1 - 2020/8

N2 - 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 non-contrast 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.

AB - 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 non-contrast 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.

KW - Adolescent

KW - Adult

KW - Aorta/diagnostic imaging

KW - Aortic Aneurysm/diagnostic imaging

KW - Cardiac-Gated Imaging Techniques

KW - Dilatation, Pathologic

KW - Electrocardiography

KW - Female

KW - Humans

KW - Magnetic Resonance Angiography

KW - Male

KW - Marfan Syndrome/complications

KW - Middle Aged

KW - Observer Variation

KW - Predictive Value of Tests

KW - Reproducibility of Results

KW - Retrospective Studies

KW - Sinus of Valsalva/diagnostic imaging

KW - Vascular Remodeling

KW - Young Adult

U2 - 10.1007/s10554-020-01850-4

DO - 10.1007/s10554-020-01850-4

M3 - SCORING: Journal article

C2 - 32314122

VL - 36

SP - 1533

EP - 1542

JO - INT J CARDIOVAS IMAG

JF - INT J CARDIOVAS IMAG

SN - 1569-5794

IS - 8

ER -