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Analysis of predictive factors for progression of type B aortic intramural hematoma with computed tomography
Eijun Sueyoshi1, Tatsuya Imada, Ichiro Sakamoto
1Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. EijunSueyoshi@aol.com
Insights
Predictors of aortic intramural hematoma (IMH) progression in Stanford type B patients were identified. Initial CT scans showing aortic diameter ≥40mm or wall thickness ≥10mm predict adverse outcomes, necessitating close monitoring.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Vascular Medicine
Background:
- Stanford type B aortic intramural hematoma (IMH) typically managed medically.
- Outcomes and progression predictors for type B IMH remain incompletely understood.
- Some type B IMH cases may lead to fatal complications or require surgical intervention.
Purpose of the Study:
- To identify predictors of aortic wall and diameter progression in Stanford type B IMH.
- To analyze initial computed tomography (CT) findings for prognostic value.
Main Methods:
- Retrospective analysis of 35 patients with type B IMH treated initially with medical therapy.
- Serial CT imaging to assess aortic diameter and wall thickness changes.
- Classification into progression or regression groups based on CT findings.
Main Results:
- 15 patients (progression group) showed increased diameter, wall thickness, dissection, or rupture.
- 20 patients (regression group) demonstrated decreased aortic diameter and wall thickness.
- Initial maximum aortic diameter ≥40 mm (PPV 86.7%, NPV 90.0%) and wall thickness ≥10 mm were significant predictors of progression (P=.0011, P=.0009).
Conclusions:
- Initial CT-measured maximum aortic diameter and wall thickness predict type B IMH progression.
- Patients with type B IMH and initial diameter ≥40 mm or thickness ≥10 mm require vigilant follow-up.
- These findings aid in risk stratification and management decisions for type B IMH.
Purpose:
For patients with Stanford type B aortic intramural hematoma (IMH), medical treatment is usually selected. However, the outcomes of patients with type B IMH are not completely understood, and some cases can have fatal complications develop or surgical treatment necessitated. The purpose of this study was to investigate predictors of progression of the affected aorta in patients with type B IMH with initial computed tomography (CT) images.
Methods:
Thirty-five patients with type B IMH were studied with serial CT images. Initially, medical therapy was selected for all patients. CT findings of the affected aorta were evaluated on admission and at follow-up. We divided the patients into two groups (progression group or regression group) on the basis of CT findings and investigated predictors of progression of the affected aorta with initial CT images.
Results:
We defined 15 patients who showed increased maximum aortic diameter (n = 14), increased maximum aortic wall thickness (n = 3), progression to overt dissection (n = 4), or rupture of the aortic wall (n = 2) during the follow-up period as the progression group. The other 20 patients, who all showed decreased maximum aortic wall and aortic wall thickness, were defined as the regression group. In the maximum aortic diameter, an optimal cutoff value of 40 mm resulted in positive predictive and negative predictive values of 86.7% and 90.0%, respectively. Both a maximum aortic diameter of 40 mm or more (P =.0011) and a maximum aortic wall thickness of 10 mm or more (P =.0009) were shown to be significantly predictive of the progression with Cox regression analysis.
Conclusion:
Maximum aortic diameter and maximum aortic wall thickness on initial CT images are predictive for progression of the affected aorta in patients with type B IMH. For type B IMH with a maximum aortic diameter of 40 mm or more or a maximum aortic wall thickness of 10 mm or more, careful follow-up studies must be required.