A 2015 review of imaging of the thoracic aorta concluded that contrast-enhanced CT was the optimal modality evaluation of the aorta after surgical repair, although MRI is also comparable and with image resolution comparable to CTA [33]. Compared with CTA of the chest and abdomen, imaging of the pelvis carries the benefit of evaluation of the iliofemoral vessels to assess for new or worsening pathology of the pelvic vessels. CTA Chest and Abdomen With IV Contrast Compared with CTA of the chest, abdomen, and pelvis, CTA of the chest and abdomen may fail to identify new or worsening pelvic pathology. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast MRA of the chest, abdomen, and pelvis without and with IV contrast can be used as an alternative to CTA for follow-up after open thoracoabdominal aortic repair. Spatial resolution of MRA is not as high as CTA, although some authors have found MRI to be an alternative option for imaging in younger patients [33]. In addition to monitoring aortic size and postsurgical complication such as anastomotic pseudoaneurysm, CTA can evaluate for graft complications, kinking or occlusion/stenosis of branches of the graft, infection, or complications including thoracoabdominal aneurysm rupture or dissection extension. MRA can also assess flow dynamics including wall stress and turbulent flow patterns, which may be valuable in certain patients [23,24]. Compared with MRA of the chest and abdomen, imaging of the pelvis carries the benefit of evaluation of the iliofemoral vessels to assess for new or worsening pathology of the pelvic vessels. The drawback of inclusion of the pelvis is increased acquisition time. MRA Chest, Abdomen, and Pelvis Without IV Contrast Evidence supporting use of MRA without IV contrast for evaluation after open thoracoabdominal aortic repair is limited compared with evidence of MRA with IV contrast.
Thoracoabdominal Aneurysm or Dissection Treatment Planning and Follow Up. A 2015 review of imaging of the thoracic aorta concluded that contrast-enhanced CT was the optimal modality evaluation of the aorta after surgical repair, although MRI is also comparable and with image resolution comparable to CTA [33]. Compared with CTA of the chest and abdomen, imaging of the pelvis carries the benefit of evaluation of the iliofemoral vessels to assess for new or worsening pathology of the pelvic vessels. CTA Chest and Abdomen With IV Contrast Compared with CTA of the chest, abdomen, and pelvis, CTA of the chest and abdomen may fail to identify new or worsening pelvic pathology. MRA Chest, Abdomen, and Pelvis Without and With IV Contrast MRA of the chest, abdomen, and pelvis without and with IV contrast can be used as an alternative to CTA for follow-up after open thoracoabdominal aortic repair. Spatial resolution of MRA is not as high as CTA, although some authors have found MRI to be an alternative option for imaging in younger patients [33]. In addition to monitoring aortic size and postsurgical complication such as anastomotic pseudoaneurysm, CTA can evaluate for graft complications, kinking or occlusion/stenosis of branches of the graft, infection, or complications including thoracoabdominal aneurysm rupture or dissection extension. MRA can also assess flow dynamics including wall stress and turbulent flow patterns, which may be valuable in certain patients [23,24]. Compared with MRA of the chest and abdomen, imaging of the pelvis carries the benefit of evaluation of the iliofemoral vessels to assess for new or worsening pathology of the pelvic vessels. The drawback of inclusion of the pelvis is increased acquisition time. MRA Chest, Abdomen, and Pelvis Without IV Contrast Evidence supporting use of MRA without IV contrast for evaluation after open thoracoabdominal aortic repair is limited compared with evidence of MRA with IV contrast.