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Background  The purpose of this study was to investigate 3D flow patterns and vessel wall parameters in patients with dilated ascending aorta, age-matched subjects, and healthy volunteers.    Methods  Thoracic time-resolved 3D phase contrast CMR with 3-directional velocity encoding was applied to 33 patients with dilated ascending aorta (diameter ≥40 mm, age=60±16 years), 15 age-matched normal controls (diameter ≤37 mm, age=68±7.5 years) and 15 young healthy volunteers (diameter ≤30 mm, age=23±2 years). 3D blood flow was visualized and flow patterns were graded regarding presence of supra-physiologic-helix and vortex flow using a semi-quantitative 3-point grading scale. Blood flow velocities, regional wall shear stress (WSS), and oscillatory shear index (OSI) were quantified.    Results  Incidence and strength of supra-physiologic-helix and vortex flow in the ascending aorta (AAo) was significantly higher in patients with dilated AAo (16/33 and 31/33, grade 0.9±1.0 and 1.5±0.6) than in controls (2/15 and 7/15, grade 0.2 ± 0.6 and 0.6 ± 0.7,  P <.05) or healthy volunteers (1/15 and 0/15, grade 0.1 ± 0.3  P <.05). Greater strength of the ascending aortic helix and vortex flow were associated with significant differences in AAo diameters ( P <.05). Peak systolic WSS in the ascending aorta and aortic arch was significantly lower in patients with dilated AAo ( P <.0157-.0488). AAo diameter positively correlated to time to peak systolic velocities (r=0.30-0.53,  P <.04), OSI (r=0.33-0.49,  P <0.02) and inversely correlated to peak systolic WSS (r=0.32-0.40,  P <.03). Peak systolic WSS was significantly lower in AAo aneurysms at the right and outer curvature within the AAo and proximal arch ( P <.01-.05).    Conclusions  Increase in AAo diameter is significantly correlated with the presence and strength of supra-physiologic-helix and vortex formation in the AAo, as well with decrease in systolic WSS and increase in OSI.

Evaluation of 3D blood flow patterns and wall shear stress in the normal and dilated thoracic aorta using flow-sensitive 4D CMR