Prevalence and Clinical Implications of Incidental Aortic Arch Abnormalities on Contrast-Enhanced Neck MR Angiography: A Single-Center Experience

Figures

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  Figure 1. Flow diagram of the enrolled patients in this study.

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  Figure 2. Incidentally detected aortic dissection (Stanford type A) during work-up for dizziness and left arm weakness. (A) In contrast-enhanced neck MR angiography (3D MIP image), there is a double-lumen lesion with intimal flap (arrow), suggesting true and false lumens in the mid to distal aortic arch involving the proximal descending aorta within the scan range. Coexisting focal stenosis is also noted in the left vertebral artery, V2 segment (arrowhead); (B) in contrast-enhanced aorta CT, the Stanford type A aortic dissection involves the whole aorta and extends to the left common and left external iliac arteries (arrows).

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  Figure 3. Incidentally detected aortic aneurysm during work-up for a headache in a patient with renal cell carcinoma. (A) In contrast-enhanced neck MR angiography (3D MIP image), there is a saccular aneurysm in the distal aortic arch (arrow). In the left distal internal carotid artery (C1 segment), a small bulging lesion is noted with a flap-like lesion, suggesting focal dissection (arrowhead). (B) In contrast-enhanced aorta CT, the aortic aneurysm is clearly depicted (arrow).

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  Figure 4. Incidentally detected aortic aneurysm during work-up for a transient ischemic attack. (A,B) In the 3D MIP images of contrast-enhanced neck MR angiography, there is a saccular aneurysm in the aortic arch (arrow in (A)). There is a coexisting segmental occlusion of the left vertebral artery, V4 segment (arrow in (B)).

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  Figure 5. Incidentally detected aortic dissection (Stanford type A) during work-up for altered mental status. (A,B) In the 3D MIP images of contrast-enhanced neck MR angiography, there is no contrast opacification of the right common carotid, right internal carotid, and right external carotid arteries, suggesting occlusion (arrows in (A)). There is an intimal flap in the distal brachiocephalic artery near the origin of the right common carotid artery, suggesting arterial dissection (arrowhead in (A). Although the aortic arch demonstrates irregular features, there is no definite evidence of dissection (B). (C) In dynamic source images of contrast-enhanced neck MRA, the Stanford type A aortic dissection is detected along the entire aortic arch. The dissection involves the origin sites of the major neck arteries, including the brachiocephalic artery, right common carotid artery, left common carotid artery, and left subclavian artery (arrows in the upper row). Moreover, it extends to the descending aorta distally (arrows in the lower row).