TY - JOUR
T1 - The future of cardiovascular magnetic resonance imaging in thoracic aortopathy
T2 - blueprint for the paradigm shift to improve management
AU - Nadel, James
AU - Rodríguez-Palomares, José
AU - Phinikaridou, Alkystis
AU - Prieto, Claudia
AU - Masci, Pier-Giorgio
AU - Botnar, René
N1 - Publisher Copyright:
© 2025 The Authors
PY - 2025/2/20
Y1 - 2025/2/20
N2 - Thoracic aortopathies result in aneurysmal expansion of the aorta that can lead to rapidly fatal aortic dissection or rupture. Despite the availability of abundant non-invasive imaging tools, the greatest contemporary challenge in the management of thoracic aortic aneurysm (TAA) is the lack of reliable metrics for risk stratification, with absolute aortic diameter, growth rate, and syndromic factors remaining the primary determinants by which prophylactic surgical intervention is adjudged. Advanced cardiovascular magnetic resonance (CMR) techniques present a potential key to unlocking insights into TAA that could guide disease surveillance and surgical intervention. CMR has the capacity to encapsulate the aorta as a complex biomechanical structure, permitting the determination of aortic volume, morphology, composition, distensibility, and fluid dynamics in a time-efficient manner. Nevertheless, current standard-of-care imaging protocols do not harness its full capacity. This state-of-the-art review explores the emerging role of CMR in the assessment of TAA and presents a blueprint for the required paradigm shift away from aortic size as the sole metric for risk-stratifying TAA.
AB - Thoracic aortopathies result in aneurysmal expansion of the aorta that can lead to rapidly fatal aortic dissection or rupture. Despite the availability of abundant non-invasive imaging tools, the greatest contemporary challenge in the management of thoracic aortic aneurysm (TAA) is the lack of reliable metrics for risk stratification, with absolute aortic diameter, growth rate, and syndromic factors remaining the primary determinants by which prophylactic surgical intervention is adjudged. Advanced cardiovascular magnetic resonance (CMR) techniques present a potential key to unlocking insights into TAA that could guide disease surveillance and surgical intervention. CMR has the capacity to encapsulate the aorta as a complex biomechanical structure, permitting the determination of aortic volume, morphology, composition, distensibility, and fluid dynamics in a time-efficient manner. Nevertheless, current standard-of-care imaging protocols do not harness its full capacity. This state-of-the-art review explores the emerging role of CMR in the assessment of TAA and presents a blueprint for the required paradigm shift away from aortic size as the sole metric for risk-stratifying TAA.
KW - 4D flow
KW - Aortic aneurysm
KW - Aortopathy
KW - Cardiac magnetic resonance imaging
UR - http://www.scopus.com/inward/record.url?scp=105002491341&partnerID=8YFLogxK
U2 - 10.1016/j.jocmr.2025.101865
DO - 10.1016/j.jocmr.2025.101865
M3 - Review article
C2 - 39986653
SN - 1097-6647
VL - 27
JO - Journal of Cardiovascular Magnetic Resonance
JF - Journal of Cardiovascular Magnetic Resonance
IS - 1
M1 - 101865
ER -