3D and 4D Imaging of the Aortic Root 3D and 4D Imaging of the Aortic Root Dominik Fleischmann Department of Radiology Stanford University Dominik Fleischmann Dominik Fleischmann Department of Radiology Department of Radiology Stanford University Stanford University 20 th Annual Summer Practicum, Masters in Body Imaging Jackson Lake Lodge, Moran, Wyoming August 8-11, 2010
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3D and 4D Imaging of the Aortic Root - Scbtmr€¦ · pre and postoperative imaging - Marfan's disease - Bicuspid aortic valve disease / aneurysm. EKG gated CTA of the Thorax (16-
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3D and 4D Imaging of the Aortic Root
3D and 4D Imaging of the Aortic Root
Dominik FleischmannDepartment of Radiology
Stanford University
Dominik FleischmannDominik FleischmannDepartment of RadiologyDepartment of Radiology
Stanford UniversityStanford University
20th Annual Summer Practicum, Masters in Body ImagingJackson Lake Lodge, Moran, Wyoming
August 8-11, 2010
Research support: Research support: General ElectricGeneral ElectricSpeaker's board: Speaker's board: BraccoBracco
SiemensSiemens
Conflicts of Interest DisclosureConflicts of Interest Disclosure
Dominik FleischmannDepartment of Radiology
Stanford University
Dominik FleischmannDominik FleischmannDepartment of RadiologyDepartment of Radiology
Stanford UniversityStanford University
20th Annual Summer Practicum, Masters in Body ImagingJackson Lake Lodge, Moran, Wyoming
••betabeta--blockers, and blockers, and subling. nitrosubling. nitro
••recon. 1 diastolic recon. 1 diastolic phase (65% of RR) phase (65% of RR)
••ECG pulsing on ECG pulsing on (dose reduction)(dose reduction)
EKG gated CTA of the ThoraxEKG gated CTA of the Thorax(16(16-- channel MDCT)channel MDCT)
s/ps/p Ross procedure (pulmonaryRoss procedure (pulmonary-- to aorta autograft)to aorta autograft)susp. leak/pseudoaneurysmsusp. leak/pseudoaneurysm
diastolediastole systolesystole
Advantages:Advantages:
••motionmotion--'free' (3D)'free' (3D) and and dynamic (4D)dynamic (4D)visualization of thor. aorta + aortic rootvisualization of thor. aorta + aortic root
••high 3D spatial resolution (0.5mmhigh 3D spatial resolution (0.5mm33))
••Sinuses of ValsalvaSinuses of Valsalvaaortic valveaortic valvecoronary ostiacoronary ostia
••Aortic anulusAortic anulus
Thoracic AortaThoracic Aorta
Surgical AnatomySurgical Anatomy
Normal diameter of thoracic aorta Normal diameter of thoracic aorta
AnulusAnulusnormal normal 2323--27mm27mm>27mm>27mm anuloaortic ectasiaanuloaortic ectasia
Thoracic aorta (incl. sinuses and STJ)Thoracic aorta (incl. sinuses and STJ)normal normal ageage--, sex, sex--, body size dependent, body size dependent'ectatic''ectatic' appears enlarged, but appears enlarged, but ≤≤4cm4cm>4.0 cm >4.0 cm aneurysm (root, asc., tra., desc.)aneurysm (root, asc., tra., desc.)
valve prolaps with severe valve prolaps with severe aortic regurgitation and left aortic regurgitation and left ventricular dilatationventricular dilatation
Bicuspid Aortic ValveBicuspid Aortic Valve
Severe prolaps of R+L Severe prolaps of R+L -- leafletleaflet
Raphe 'L+R' leafletRaphe 'L+R' leaflet
Bicuspid Aortic ValveBicuspid Aortic Valve
Severe prolaps of R/LSevere prolaps of R/L--cuspcuspdue to rupture of commissural suspensory 'chord'due to rupture of commissural suspensory 'chord'
'L+R' sinus'L+R' sinusraphe/chordraphe/chord
3D and 4D Imaging of the Aortic Root3D and 4D Imaging of the Aortic Root