New Development of an Ulcerlike Projection in Aortic Intramural Hematoma: CT Evaluation

Sueyoshi, Eijun; Matsuoka, Yoshikazu; Imada, Tatsuya; Okimoto, Tomoaki; Sakamoto, Ichiro; Hayashi, Kuniaki

doi:10.1148/radiol.2242011009

Cited by 110 publications

(88 citation statements)

References 24 publications

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“…Development of ulcerlike projections during follow-up has been reported to be a predictor of poor prognosis in patients with both proximal and distal IMH ( 9,35 ). One of the key features of IMH is its evolving behavior over the course of time, and the appearance of this lesion can be interpreted differently depending on when a diagnostic examination is performed ( 1 ); hence, this ulcerlike projection likely occurs midway through the evolution of IMH.…”

Section: Discussionmentioning

confidence: 99%

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

Park¹,

Ahn²,

Kim³

et al. 2011

Radiology

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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

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Section: Discussionmentioning

confidence: 99%

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

Park¹,

Ahn²,

Kim³

et al. 2011

Radiology

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“…1 However, classic AD was defined as the dissection with visible intimal tear and flow communication between true and false lumen. Because ulcer-like projection (ULP) has been considered to represent the site of an intimal disruption, 14 patients who showed ULP or penetrating atherosclerotic ulcer (PAU) into the hematoma space on the initial CT were excluded even though imaging modalities showed typical crescent aortic wall thickness. Figure 1 summarizes the therapeutic strategy for patients with type A IMH.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…First, we excluded patients who showed ULP or PAU in the initial CT images, because the definition of IMH with ULP or PAU was complicated by confusing and overlapping medical terminology. 14,20,24,25 Besides, it was regarded as AD with thrombosed false lumen in several works of literature. 16,25 Because ULP and PAU were reported to be the risk factors for the progressive disease course, 14,20 exclusions of these patients might lead to better clinical outcomes.…”

Section: Kitai Et Al Clinical Outcomes Of Patients With Type a Imh S295mentioning

confidence: 99%

Clinical Outcomes of Medical Therapy and Timely Operation in Initially Diagnosed Type A Aortic Intramural Hematoma

et al. 2009

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Background-The management of aortic intramural hematoma (IMH) involving the ascending aorta (type A) has not been well-established. The purpose of this study was to clarify the long-term clinical outcomes of patients with type A IMH who were treated with medical therapy and timely operation. Methods and Results-Clinical data including operative mortality, IMH-related events, and long-term survival were retrospectively reviewed in 66 patients with type A IMH, who were admitted to our institution from 1986 to 2006. Emergent surgical repair was performed in 16 (24%) patients because of severe complications, whereas 50 patients were treated with initial medical therapy. In medically treated patients, 15 (30%) patients who demonstrated progression to classic dissection or increase in hematoma size within 30 days underwent surgical repair except for 2 patients who refused surgery. The 30-day mortality rate was 6% with emergent surgery and 4% with supportive medial therapy. There were 7 late deaths and the actuarial survival rates of all patients were 96Ϯ3%, 94Ϯ3%, and 89Ϯ5% at 1, 5, and 10 years, respectively. In medically treated patients, maximum aortic diameter was the only predictor of early and late progression of ascending IMH (hazard ratio, 4.43; 95% CI, 2.04 -9.64; PϽ0.001). Aortic diameter Ն50 mm predicted progression of ascending IMH with the positive and negative value of 83% and 84%, respectively. Conclusions-Combination

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“…4,5,9,12,13 Although this process has been believed to be reentry tear formation secondary to hematoma expansion, 10 it is also possible that these patients initially had intimal defect, but the false lumen was completely thrombosed without flow communication between true and false lumens. Likewise, previous study reported that plaque rupture may be the cause of IMH in a previously unrecognized subgroup of patients.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2011

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New Development of an Ulcerlike Projection in Aortic Intramural Hematoma: CT Evaluation

Abstract: The location of ulcerlike projections is the principal predictor of progression, and careful follow-up study is needed for patients with an ulcerlike projection located from the ascending aorta to the aortic arch.

Cited by 110 publications

References 24 publications

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

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

Clinical Outcomes of Medical Therapy and Timely Operation in Initially Diagnosed Type A Aortic Intramural Hematoma

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

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