Non-gadolinium-enhanced 3-dimensional magnetic resonance angiography for the evaluation of thoracic aortic disease: a preliminary experience.

We compared image quality and diagnostic accuracy of a noncontrast 3-dimensional magnetic resonance angiography (NC-MRA) technique (balanced steady-state free-precession sequence) to contrast-enhanced MRA (CE-MRA) for evaluation of thoracic aortic disease.The CE-MRA provides 3-dimensional high-resolution images of the thoracic aorta that are important in the evaluation of patients with aortic disease. However, recent concerns with the potential nephrotoxic effects of gadolinium contrast medium limit the application of CE-MRA for patients who have significant renal insufficiency.Twenty-one patients (mean age, 51 yr; 18 men) who underwent NC-MRA and CE-MRA for evaluation of thoracic aortic disease were retrospectively identified. Data sets were reviewed by 2 readers who were blinded to the patients' information. The thoracic aorta was divided into 5 segments. Image quality and reader confidence for diagnosis of aortic pathology were rated on 5-point scales. The Wilcoxon matched-pairs signed rank test and the Student t test were used for comparisons.The NC-MRA identified all pathologic findings with 100% diagnostic accuracy and similar reader confidence, when compared with CE-MRA. Although overall image quality was not significantly different, superior image quality was observed at the aortic root (4.4 +/- 0.8 vs 3.2 +/- 0.9, P <0.0005) and ascending aorta (4.1 +/- 1 vs 3.7 +/- 0.9, P=0.05) respectively.In conclusion, NC-MRA is a useful alternative for evaluation and follow-up of thoracic aortic disease, especially for patients with poor intravenous access or contraindications to gadolinium use.