Important reduction of artifacts

Important reduction of artifacts and thus decreasing pitfalls, can be achieved by:

• Contrast injection in RIGHT arm: no contrast crossing in front of arch side branches which distorts visibility of intima flaps (figure)
• saline bolus chaser (only contrast in lumina of interest)
• EKG-triggered imaging (less motion artifacts mimicking intima flap)
Also keep in mind that placing ROIs can be difficult with dissected lumina (should be just distal to the aortic arch).) Have the technician be prepared to manually start upon visual feedback. 

 

Type A dissection extending into the brachiocephalic arteries.
LEFT: not visible on left arm injection.
RIGHT: Same patient with right arm injection.