title: 3D MRI provides improved visualization and detection of aortic arch plaques compared to transesophageal echocardiography.
abstract: OBJECTIVE
  To compare 3D magnetic resonance imaging (3D MRI) with transesophageal echocardiography (TEE) for the detection of complex aortic plaques (≥4 mm thick, ulcerated, or containing mobile thrombi).
  
  
  METHODS
  In all, 99 consecutive patients with acute cryptogenic stroke and ≥3 mm thick aortic plaques in TEE were prospectively included. 3D MRI comprised T1-weighted bright blood MRI with complete aortic coverage (spatial resolution 1 mm(3) ). Wall thickness and occurrence of complex plaques in ascending aorta (AAo), aortic arch (AA), and descending aorta (DAo) and image quality for each segment was rated for MRI and TEE.
  
  
  RESULTS
  MRI detected more complex plaques than TEE (MRI vs. TEE): AAo 13 vs. 7; AA 37 vs. 11; differences were smaller in the DAo: 101 vs. 70. Image quality was higher for MRI in AAo and AA (P < 0.001) and superior for TEE in DAo (P < 0.001). MRI revealed additional complex plaques in the proximal aorta in 19 of 58 patients (32.8%) categorized as cryptogenic after complete routine diagnostics including TEE.
  
  
  CONCLUSIONS
  Due to improved visualization of the aorta 3D MRI allows to detect more complex plaques than TEE. This renders 3D MRI particularly valuable for patients with cryptogenic stroke and for trials evaluating optimal treatment in aortic atherosclerosis.
authors.affiliation: Department of Neurology, University Hospital Freiburg, Breisacher Strasse 64, Freiburg, Germany. andreas.harloff@uniklinik-freiburg.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Harloff
authors.forename: Stefanie Marie
authors.initials: SM
authors.lastname: Brendecke
authors.forename: Jan
authors.initials: J
authors.lastname: Simon
authors.forename: Dawit
authors.initials: D
authors.lastname: Assefa
authors.forename: Wolf
authors.initials: W
authors.lastname: Wallis
authors.forename: Thomas
authors.initials: T
authors.lastname: Helbing
authors.forename: Johannes
authors.initials: J
authors.lastname: Weber
authors.forename: Alex
authors.initials: A
authors.lastname: Frydrychowicz
authors.forename: Werner
authors.initials: W
authors.lastname: Vach
authors.forename: Cornelius
authors.initials: C
authors.lastname: Weiller
authors.forename: Michael
authors.initials: M
authors.lastname: Markl
mesh_terms: D000368:Aged; D000465:Algorithms; D001013:Aorta, Thoracic / Q000473:pathology*; D001018:Aortic Diseases / Q000473:pathology*; D050197:Atherosclerosis / Q000473:pathology*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity