Atheromas of the thoracic aorta: A comparison of transesophageal echocardiography and breath-hold gadolinium-enhanced 3-dimensional magnetic resonance angiography

Transesophageal echocardiography (TEE) has been the procedure of choice for identifying thoracic aortic atheromas. All patients over a 2-year period w ho underwent both TEE and magnetic resonance angiography of the thoracic ao rta within 1 month were identified. The largest plaque in 3 aortic segments (ascending, arch, and descending) was measured. Thirty patients (16 men; 6 6.8 +/- 12.9 years) were studied. The mean size of the atheromas in the arc h was larger as measured by TEE compared with magnetic resonance angiograph y (3.4 vs 1.4 mm, P = .01). However, the mean atheroma size was similar in the ascending aorta (1.9 vs 1.3 mm, P = .5) and descending aorta (3.9 vs 3. 5 mm, P = .66). Of 24 aortic segments with plaques measuring greater than o r equal to 5 mm (with high embolic risk), 22 (92%) were seen on TEE and onl y 13 (54%) on magnetic resonance angiography (P = .003). In conclusion, alt hough both techniques are complementary, TEE does identify more high-risk p laques.