Distal Aortic Intramural Hematoma: Clinical Importance of Focal Contrast Enhancement on CT Images

Abstract

Purpose:To investigate the prevalence, fate, and effect of focal contrast enhancement lesion within the hematoma on contrast material-enhanced computed tomographic (CT) images in patients with distal aortic intramural hematoma (IMH). Materials and Methods:This retrospective study was approved by the institutional review board; informed consent was waived. Clinical and CT data in 107 patients with distal IMH who received medical treatment were analyzed, including remodeling processes of IMH at follow-up CT. IMH progression was defi ned as development of aortic dissection (AD) and aneurysm or hematoma increase. Results:The frequency of focal contrast enhancement was 39.3%, and hematoma was thicker in patients with focal contrast enhancement than in those without (12.3 mm 6 3.6 [standard deviation] vs 10.1 mm 6 4.1, P = .006). Although development of AD occurred more frequently in patients with focal contrast enhancement (21 % vs 3%, P = .006), hematoma resorption (57% vs 71%) was the most common pattern of remodeling in both groups without any signifi cant difference ( P = .148). The frequency of development of aortic aneurysm (17% vs 14%, P = .690) and increase of hematoma (0% vs 5%, P = .278) was not signifi cantly different between groups. The 1-, 3-, 5-, and 7-year survival rates were 96.3% 6 1.8, 95.2% 6 2.1, 87.9% 6 3.4, and 80.7% 6 4.4, respectively. Patients with IMH progression showed lower survival rates than those without ( P = .028). While no signifi cant difference in the overall survival rates could be demonstrated in patients with and those without focal contrast enhancement ( P = .442), our study had only 17% power to detect a difference of 10%. Initial maximal aortic diameter was the only factor associated with survival rates (hazard ratio = 1.129 ; 95% confi dence interval: 1.063, 1.199). The optimal cutoff for prediction of mortality within 7 years was 41 mm. Conclusion:Urgent intervention for patients with focal contrast enhancement is not necessary during the acute stage, and long-term close monitoring with imaging is a better option considering diverse remodeling processes of distal IMH.q RSNA, 20111 From the Divisions of Cardiology

Detection of Intimal Defect by 64-Row Multidetector Computed Tomography in Patients With Acute Aortic Intramural Hematoma

“…Besides, 5 patients showed complete resorption of intimal defect. This finding was consistent with a previous study 16 showing variable remodeling processes of focal contrast enhancement within a hematoma in patients with distal IMH. Additional studies with a larger number of patients and longer follow-up are needed.…”

Aortic intramural hematoma: aspects of pathogenesis 2011

“…IRAD data showed that, of 639 patients with type A acute aortic syndrome involving the ascending aorta, 23 (4%) showed intramural hematoma, while of 371 patients with type B acute aortic syndrome, 35 (9%) showed hematoma [10]. In our institution, the incidences of type A and B intramural hematoma were 28% (101/357) and 45% (159/350), respectively [11,13]. Thus, the incidence of intramural hematoma is much higher in Eastern countries.…”

“…6). We have recently reported that this phenomenon is common in patients with distal intramural hematoma and is a risk factor for the development of localized aortic dissection during follow-up [13]. However, as hematoma resorption was the most common remodeling process and actually occurred in 70% of patients with focal contrast enhancement, early intervention during the acute stage is not necessary, and long-term imaging follow-up would be the best option (.…”

Numerical Simulation in Ulcer-Like Projection due to Type B Aortic Dissection with Complete Thrombosis Type

“…An ulcer-like projection (ULP) that occurs during the course of the complete thrombosis type [10,11] and a penetrating atherosclerotic ulcer (PAU) due to an arteriosclerotic ulcer [12,13] are conceptually different.ULP is an ulcerative projection image of the contrast medium that comparatively has a smooth outline and is a defect of the inner membrane continuous to the false lumen was condensed. Recently, ULP is treated as subtype (ULP type in aortic dissection) [1].…”