MRI has the advantage that images can be obtained in any plane and intravenous contrast may not be required. It is difficult to image and monitor very sick patients in conventional closed-bore MRI scanners; however, the new designs of open scanner are considerably better suited. MRI shows the extent of dissection and allows visualization of the arch and other vessel involvement ( Fig 3). It will also show aortic regurgitation and rupture into the pericardium. MRI can be adapted to the specific clinical requirements, allowing detailed anatomical imaging with cardiac gated spin echo and gradient echo sequences, and directional blood flow assessment with phase contrast angiography and velocity mapping. As magnetic resonance technology advances, faster imaging techniques will improve its usefulness.
Fig. 3 Axial MRI of aortic arch dissection at a similar level but in a different patient to Fig..2, demonstrating similar features. (Courtesy of The Royal Brompton Hospital, London, UK.)
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