Pseudoaneurysms of the Ascending Aorta Demonstrated With “Motion-Free” Multislice Computed Tomography
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⇓).
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.
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.