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It's Topic Tuesday!

Happy Topic Tuesday family!

Welcome back to our weekly educational sessions. We hope you enjoyed Duc’s post last week going over some CT and echo imaging for aortic disease! These are two invaluable ways doctors could help diagnose and monitor the your aorta and guide treatment. Here’s a quick challenge to start your morning: is the following image an example of an echocardiography or a CT scan? (And for our really ambitious readers! - Is it showing an aneurysm or a dissection?)

(From St. Vincent’s University Hospital)

This week, we want to build on our imaging theme by discussing a new type of test called - Magnetic Resonance Angiography commonly known as “MRA”. Check out this great summary from Johns Hopkins Medicine -

It is possible that you are more familiar with a related test called an “MRI” or magnetic resonance image, which works by using radio waves and magnetic physical properties to create an image. MRA is a special type of MRI which is able to look at an individual’s blood vessels without the need for catheterization.

Pro tip! - The word Angiography will always refer to the act of visualizing within blood vessels and organs, including arteries and veins. In our case here, an MRA will help us look within the aorta and see any ballooning (aneurysmal formation) or dissection!

During an MRA, you will be fully awake and asked to lay down within a large tube-like MRI scanner. It is important for you to stay as still as you can! This will help reduce “artifact” on the scan, and allow for a clearer image for the radiologist.

Using an MRA scanner will allow your healthcare providers to see exactly where along the aorta an aneurysm or dissection has formed, the diameter and length of the disease, as well as if it includes any “branch” vessels coming off the aorta (such as your renal arteries or arteries to your abdominal organs).

For aortic diseases, doctors may order a “contrast”-enhanced MRA. The principle here is very similar to contrast used in CT scans, in which iodine-based dye was injected intra-venously to help enhance the quality of the image and highlight any areas receiving increased or decreased blood flow.

For dissections, MRA’s will also help distinguish between true and false lumens and help show recovery after surgery:

While an MRA is a very low-risk procedure, there are some things to be mindful of:

  • First and foremost, NO METAL! As stated before, MRAs and MRIs work using magnetic properties and sound waves. The machine is basically a huge magnet and IT WILL attract several forms of metal and jewelry.

  • If you are a loved one have ever had a metallic implant put in (knees, hip, joint surgeries), metallic valve, or pacemaker, it is crucial to bring this up to your physician to see if the material will interfere with the machine.

  • Be sure to remove any and all earrings, rings, necklaces, and bracelets before your MRA.

  • Additionally, if you have ever had a tattoo done at home or outside of a licensed tattoo parlor, be sure to bring it up as some tattoo inks may contain metallic components.

With regards to contrast-enhanced MRA, some people may experience mild discomfort during dye insertion, including tingling at the injection site or abnormal taste. These symptoms often go away on their own but be sure to communicate any and all discomforts to your doctors so you are all on the same page!

Finally, if you or a family member have ever had an allergy to contrast dye or if you have ever been told you have kidney disease, doctors may decide to not use dye at all or to decrease its amount during the image so be sure to mention it at your appointment.

And that wraps up this week’s session! Be sure to check out our previous posts if you are interested in other imaging modalities for aortic disease! Thank you to everyone who tuned in and as always our family here thanks you for taking this journey with us.

Until next time, let’s remember to always Think Aorta.

- Adham

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