Magnetic resonance imaging of aneurysms and thrombi

Left Atrial Appendage Aneurysm: A Case Report and Literature Review

The left atrial appendage aneurysm is an uncommon condition that has garnered attention from the medical community due to its low incidence and varied clinical manifestations. The difficulty in identification is reflected in its incidental detection in imaging studies such as echocardiograms and tomographies, while symptoms range from mild to severe, including heart failure and thromboembolic events. The complex etiology includes congenital and acquired factors, and its management focuses on preventing complications through surgical resection, accompanied by medical strategies such as controlling heart rhythm and anticoagulation. The case of a 67-year-old woman with significant medical history illustrates these challenges. Despite an inconclusive initial diagnosis, a tomography revealed an aneurysm with an intracavitary thrombus, leading to successful surgical resection. However, subsequent infectious complications resulted in her death. The average age of diagnosis is around 30 years, and while it is more common in women, there are no significant gender differences. Surgical management remains the preferred option, especially in severe cases, although in some patients, a watchful waiting approach is chosen. In conclusion, the left atrial appendage aneurysm is a complex entity that requires a multidisciplinary approach to improve clinical outcomes. Early diagnosis and appropriate treatment are crucial to prevent serious complications and improve the quality of life of affected patients.

Assessment of abdominal aortic aneurysm with magnetic resonance imaging

Pre-operative imaging of abdominal aortic aneurysms (AAA) is important in determining suitability for operation and operative approach. Ultrasound imaging is an excellent screening modality but is relatively poor at identifying renal arteries and the extent of iliac involvement. Computed tomography scanning with intravenous contrast and arteriography are invasive modalities that are associated with a small risk. Magnetic resonance imaging (MRI) offers the potential of accurate anatomical definition without use of contrast agents and passage of an intra-arterial catheter. Eight patients who had their AAA evaluated with MRI are reported. All had renal arteries accurately defined, intra-aneurysmal thrombosis was well delineated, and iliac extension was correctly identified in four cases. The initial experience has been most encouraging and the authors consider that MRI may become the investigation of choice for pre-operative AAA assessment.

Magnetic resonance imaging of the thoracic aorta

Magnetic resonance imaging (MRI) is steadily becoming recognized as a premier imaging modality for evaluating the thoracic aorta. Its noninvasive, nonimaging approach and refined resolution capabilities effectively combine the advantages of echocardiography, angiography, and computed tomography (CT) under the auspices of a single imaging device. On static spin-echo MRI, blood flow appears dark, allowing superb depiction of both intra- and extra vascular anatomy. With dynamic MR studies, gradient echo (cine) and phase velocity mapping techniques have proven effective in assessing the physiological consequences of anatomic vascular abnormalities in a qualitative and quantitative manner, respectively. Magnetic resonance angiography (MRA) is fast becoming a prominent vascular imaging method. Although still evolving, MRA bolsters the vascular imaging capabilities of MRI by enhancing the imaging resolution of the major branch vessels and collateral vessels. With continued advances in this area, MRI may adopt the role as the primary imaging method for assessing the thoracic aorta.

Prospective double-blinded comparison of MR imaging and aortography in the preoperative evaluation of abdominal aortic aneurysms

The authors conducted a prospective double-blind study comparing spin-echo axial and coronal magnetic resonance (MR) imaging with aortography in the preoperative evaluation of 20 patients with abdominal aortic aneurysms. Receiver-operating-characteristic (ROC) analysis was used to evaluate the performance of MR imaging versus aortography in assessing arterial stenotic disease. Both modalities were equivalent in demonstrating the upper extent of the abdominal aortic aneurysms with respect to the renal and visceral arteries. MR imaging was superior in demonstrating aneurysmal iliac arteries and intraluminal thrombus. Although aberrant venous anatomy, associated pathologic changes, and other concomitant lesions were demonstrated with MR imaging, it performed poorly in assessing arterial stenoses and occlusions. Thus, the authors caution against the routine substitution of spin-echo MR imaging for aortography in the evaluation of abdominal aortic aneurysms. Conventional angiography should continue to be performed in patients with suspected mesenteric ischemia, significant hypertension, and symptomatic iliofemoral atherosclerosis, at least until robust MR angiographic techniques have proved themselves under similar rigorous clinical evaluation.

MRI of cardiac pseudoaneurysm and other complications of myocardial infarction

The purpose of this paper is to review the spectrum of pathology revealed by cardiac magnetic resonance (MR) in the evaluation of myocardial infarction. In addition, the paper is intended to provide a concise introduction to the capabilities and limitations of MR in the evaluation of myocardial infarction and its complications. To provide this introductory guide, three cases of infarction are reviewed in detail, including one unusual case of infarction with both true and false ventricular aneurysm formation. A selected review of the literature is included to demonstrate the current role of MR in the work-up and follow-up of acute infarction.

Left ventricular aneurysm in short axis: a comparison of magnetic resonance, ultrasound and thallium-201 SPECT images

Short axis magnetic resonance images of a left ventricular aneurysm were compared to similar views obtained by echocardiography and by thallium-201 single photon emission computed tomography. Images of the dyskinetic left ventricular apex and the contractile left ventricular base were analyzed and compared. Unlike the previously reported orthogonal plane magnetic resonance images, short axis imaging provided representative and quantitative information in views comparable to those obtained by standard noninvasive imaging techniques. These data indicate that short axis magnetic resonance imaging is capable of identifying and sizing the aneurysmal and the residual segments of the left ventricle. The findings may be of prognostic value in patients with left ventricular aneurysm.