MR imaging of congenital anomalies of the aortic arch

TLDR

Eighteen patients with congenital aortic arch anomalies were examined using ECG‑gated MR imaging, with transverse images for all and sagittal or coronal views in 12, allowing assessment of arch orientation, vessel origin and course, associated intracardiac defects, and compression of the trachea or esophagus. MR identified 13 right aortic arches (10 with mirror‑image branching and 3 with aberrant left subclavian), 3 left arches with aberrant right subclavian, 2 double arches, and tracheal compression in 2 symptomatic patients; in 16 of 17 cases MR findings matched angiography, surgery, CT, or autopsy, supporting its use as a noninvasive diagnostic alternative.

Abstract

Eighteen patients with congenital aortic arch anomalies were evaluated by ECG-gated MR imaging. Transverse images encompassing the heart and thoracic aorta were available in all patients; sagittal or coronal studies were available in 12 patients. Visualization of the aortic arch, its orientation, and the origin and course of the arch vessels was assessed. Associated intracardiac abnormalities were noted, and the effect of aberrant vessels on the trachea or esophagus was determined. Thirteen patients had a right aortic arch. Mirror-image branching was found in 10 cases, and an aberrant left subclavian artery was found in three of these. Three patients had a left aortic arch with aberrant right subclavian artery, and two patients had a double arch. Tracheal compression caused by vascular rings was found in two patients with respiratory symptoms. Corroborating studies (angiography, surgery, CT, and autopsy) in 16 patients confirmed the MR diagnoses in all but one. We conclude that MR could substitute for other techniques as an effective, noninvasive method for the evaluation of congenital aortic arch anomalies.