Exploring the Thoracic Aorta with Advanced Magnetic Resonance Imaging Beyond Routine Diameter Measurements

  • Alban RedheuilEmail author


Magnetic resonance imaging has emerged as a noninvasive modality for multiparametric assessment of aortic anatomy, dynamics, and flow. Preventive aortic surgery remains based on maximal aortic diameters, but this strategy has shown its limits to accurately predict acute aortic events. Novel imaging biomarkers such as aortic volumetry, aortic stiffness (distensibility and pulse wave velocity), and flow with new 4D techniques providing wall shear stress or relative pressure maps are promising to enhance our understanding of aortic pathophysiology in vivo and ability to predict adverse aortic outcome.


Specimen Molecular Diagnosis Handling Reporting Pathology 



We wish to thank Thomas Dietenbeck and Benjamin Dubourg, MD, for their kind help in generating volumetric and 4D flow images to illustrate this chapter. We wish to thank Nadjia Kachenoura, PhD, and Philippe Cluzel, MD, PhD, for their constant support.


  1. 1.
    Elefteriades JA, Farkas EA. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. J Am Coll Cardiol. 2010;55:841–57.CrossRefGoogle Scholar
  2. 2.
    Cavalcante JL, Lima JAC, Redheuil A, Al-Mallah MH. Aortic stiffness: current understanding and future directions. J Am Coll Cardiol. 2011;57:1511–22.CrossRefGoogle Scholar
  3. 3.
    Goldstein SA, Evangelista A, Abbara S, Arai A, Asch FM, Badano LP, et al. Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2015;28:119–82.CrossRefGoogle Scholar
  4. 4.
    Gautier M, Detaint D, Fermanian C, Aegerter P, Delorme G, Arnoult F, et al. Nomograms for aortic root diameters in children using two-dimensional echocardiography. Am J Cardiol. 2010;105:888–94.CrossRefGoogle Scholar
  5. 5.
    Teixido-Tura G, Almeida ALC, Choi E-Y, Gjesdal O, Jacobs DR, Dietz HC, et al. Determinants of aortic root dilatation and reference values among young adults over a 20-year period: coronary artery risk development in young adults study. Hypertension. 2015;66:23–9.CrossRefGoogle Scholar
  6. 6.
    Devereux RB, de Simone G, Arnett DK, Best LG, Boerwinkle E, Howard BV, et al. Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons ≥15 years of age. Am J Cardiol. 2012;110:1189–94.CrossRefGoogle Scholar
  7. 7.
    Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.CrossRefGoogle Scholar
  8. 8.
    Redheuil A, Yu W-C, Wu CO, Mousseaux E, de Cesare A, Yan R, et al. Reduced ascending aortic strain and distensibility: earliest manifestations of vascular aging in humans. Hypertension. 2010;55:319–26.CrossRefGoogle Scholar
  9. 9.
    Markl M, Kilner P, Ebbers T. Comprehensive 4D velocity mapping of the heart and great vessels by cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2011;13:7.CrossRefGoogle Scholar
  10. 10.
    Liu C-Y, Chen D, Bluemke DA, Wu CO, Teixido-Tura G, Chugh A, et al. Evolution of aortic wall thickness and stiffness with atherosclerosis: long-term follow up from the multi-ethnic study of atherosclerosis (MESA). Hypertension. 2015;65:1015–9.CrossRefGoogle Scholar
  11. 11.
    Malayeri AA, Natori S, Bahrami H, Bertoni AG, Kronmal R, Lima JA, et al. Relation of aortic wall thickness and distensibility to cardiovascular risk factors (from the multi-ethnic study of atherosclerosis [MESA]). Am J Cardiol. 2008;102:491–6.CrossRefGoogle Scholar
  12. 12.
    Turkbey EB, Jain A, Johnson C, Redheuil A, Arai AE, Gomes AS, et al. Determinants and normal values of ascending aortic diameter by age, gender, and race/ethnicity in the multi-ethnic study of atherosclerosis (MESA). J Magn Reson Imaging. 2014;39:360–8.CrossRefGoogle Scholar
  13. 13.
    Voges I, Jerosch-Herold M, Hedderich J, Pardun E, Hart C, Gabbert DD, et al. Normal values of aortic dimensions, distensibility, and pulse wave velocity in children and young adults: a cross-sectional study. J Cardiovasc Magn Reson. 2012;14:77.CrossRefGoogle Scholar
  14. 14.
    Burman ED, Keegan J, Kilner PJ. Aortic root measurement by cardiovascular magnetic resonance: specification of planes and lines of measurement and corresponding normal values. Circ Cardiovasc Imaging. 2008;1:104–13.CrossRefGoogle Scholar
  15. 15.
    Gupta S, Berry JD, Ayers CR, Peshock RM, Khera A, de Lemos JA, et al. Left ventricular hypertrophy, aortic wall thickness, and lifetime predicted risk of cardiovascular disease: the Dallas heart study. JACC Cardiovasc Imaging. 2010;3:605–13.CrossRefGoogle Scholar
  16. 16.
    Hickson SS, Butlin M, Graves M, Taviani V, Avolio AP, McEniery CM, et al. The relationship of age with regional aortic stiffness and diameter. JACC Cardiovasc Imaging. 2010;3:1247–55.CrossRefGoogle Scholar
  17. 17.
    Redheuil A, Yu W-C, Mousseaux E, Harouni AA, Kachenoura N, Wu CO, et al. Age-related changes in aortic arch geometry: relationship with proximal aortic function and left ventricular mass and remodeling. J Am Coll Cardiol. 2011;58:1262–70.CrossRefGoogle Scholar
  18. 18.
    Sugawara J, Hayashi K, Yokoi T, Tanaka H. Age-associated elongation of the ascending aorta in adults. JACC Cardiovasc Imaging. 2008;1:739–48.CrossRefGoogle Scholar
  19. 19.
    Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, Hayoz D, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27:2588–605.CrossRefGoogle Scholar
  20. 20.
    Herment A, Kachenoura N, Lefort M, Bensalah M, Dogui A, Frouin F, et al. Automated segmentation of the aorta from phase contrast MR images: validation against expert tracing in healthy volunteers and in patients with a dilated aorta. J Magn Reson Imaging. 2010;31:881–8.CrossRefGoogle Scholar
  21. 21.
    De Cesare A, Redheuil A, Dogui A, Engineer O, Lalande A, Frouin F, et al. “ART-FUN”: an integrated software for functional analysis of the aorta. J Cardiovasc Magn Reson. 2009;11:P182.CrossRefGoogle Scholar
  22. 22.
    Redheuil A, Wu CO, Kachenoura N, Ohyama Y, Yan RT, Bertoni AG, et al. Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study. J Am Coll Cardiol. 2014;64:2619–29.CrossRefGoogle Scholar
  23. 23.
    Teixido-Tura G, Redheuil A, Rodríguez-Palomares J, Gutiérrez L, Sánchez V, Forteza A, et al. Aortic biomechanics by magnetic resonance: early markers of aortic disease in Marfan syndrome regardless of aortic dilatation? Int J Cardiol. 2014;171:56–61.CrossRefGoogle Scholar
  24. 24.
    Prakash A, Adlakha H, Rabideau N, Hass CJ, Morris SA, Geva T, et al. Segmental aortic stiffness in children and young adults with connective tissue disorders CLINICAL PERSPECTIVE: relationships with age, aortic size, rate of dilation, and surgical root replacement. Circulation. 2015;132:595–602.CrossRefGoogle Scholar
  25. 25.
    Hope LJ, Markl M, Draney M, Wilson N, Herfkens R. Four-dimensional magnetic resonance velocity mapping: velocity profile of blood-flow through the thoracic aorta in 10 healthy volunteers. J Magn Reson. 2004;11:2004.Google Scholar
  26. 26.
    Maroules CD, Khera A, Ayers C, Goel A, Peshock RM, Abbara S, et al. Cardiovascular outcome associations among cardiovascular magnetic resonance measures of arterial stiffness: the Dallas heart study. J Cardiovasc Magn Reson. 2014;16:33.CrossRefGoogle Scholar
  27. 27.
    Ohyama Y, Teixido-Tura G, Ambale-Venkatesh B, Noda C, Chugh AR, Liu C-Y, et al. Ten-year longitudinal change in aortic stiffness assessed by cardiac MRI in the second half of the human lifespan: the multi-ethnic study of atherosclerosis. Eur Heart J Cardiovasc Imaging. 2016;17:1044–53.CrossRefGoogle Scholar
  28. 28.
    Bollache E, Kachenoura N. Numerical modeling of arterial pulse wave propagation to characterize aortic hemodynamic: validation using magnetic resonance data. IRBM. 2013;34:86–9.CrossRefGoogle Scholar
  29. 29.
    Bensalah ZM, Bollache E, Kachenoura N, De Cesare A, Redheuil A, Mousseaux E. Ascending aorta backward flow parameters estimated from phase-contrast cardiovascular magnetic resonance data: new indices of arterial aging. J Cardiovasc Magn Reson. 2012;14:P128.CrossRefGoogle Scholar
  30. 30.
    Barker AJ, Markl M, Bürk J, Lorenz R, Bock J, Bauer S, et al. Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging. 2012;5:457–66.CrossRefGoogle Scholar
  31. 31.
    Guzzardi DG, Barker AJ, van Ooij P, Malaisrie SC, Puthumana JJ, Belke DD, et al. Valve-related hemodynamics mediate human bicuspid Aortopathy: insights from wall shear stress mapping. J Am Coll Cardiol. 2015;66:892–900.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Cardiovascular Imaging DICVRITInstitute of Cardiology, Pitié-Salpêtrière HospitalParisFrance
  2. 2.Sorbonne Université, Pierre et Marie Curie School of Medicine, UPMCParisFrance
  3. 3.LIB Biomedical Imaging Laboratory, INSERM/CNRS/UPMCParisFrance
  4. 4.ICAN Institute of Cardiometabolism and Nutrition, Imaging Core LabParisFrance

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