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CT analysis of the growth rate of aortic diameter affected by acute type B intramural hematoma
Eijun Sueyoshi1, Ichiro Sakamoto, Masataka Uetani
1Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Insights
Acute type B intramural hematoma patients rarely experience aortic enlargement. However, aortic diameter may increase after one year, especially with initial diameters over 40mm or false lumen blood flow.
Area of Science:
- Cardiovascular Research
- Vascular Surgery
- Medical Imaging
Background:
- Acute type B intramural hematoma is a serious vascular condition.
- Understanding aortic diameter changes is crucial for patient management.
- Predicting enlargement risk aids in timely intervention.
Purpose of the Study:
- To determine the growth rate of aortic diameter in patients with acute type B intramural hematoma.
- To identify factors influencing aortic enlargement in these patients.
Main Methods:
- Retrospective analysis of 54 patients with acute type B intramural hematoma.
- Regular follow-up CT scans over a mean of 46.9 months.
- Evaluation of 127 aortic and iliac segments for diameter changes and growth rates.
- Statistical analysis including univariate and multivariate logistic regression to identify risk factors.
Main Results:
- Only 37% of patients showed segment enlargement; 27.6% of segments increased in size.
- The overall mean growth rate was -0.5 mm/year (indicating shrinkage).
- Growth rates differed significantly between the first year (-2.2 mm/year) and after 1 year (0.4 mm/year).
- Initial aortic diameter ≥40 mm and presence of blood flow in the false lumen were significant risk factors for enlargement.
Conclusions:
- Aortic enlargement is not highly frequent in acute type B intramural hematoma during follow-up.
- A tendency for aortic size increase is observed after one year post-onset.
- Large initial diameter and false lumen blood flow are key predictors of aortic enlargement.
Objective:
The purpose of this study was to evaluate the growth rate of aortic diameter affected by acute type B intramural hematoma and the factors that influence its enlargement.
Materials And Methods:
Fifty-four patients were entered into this study, and regular follow-up CT studies (mean +/- SD, 46.9 +/- 27.2 months; range, 5-136 months) were performed. The affected aortas and iliac arteries were divided into five segments. A total of 127 segments were evaluated (aortic arch, n = 47; descending thoracic aorta, n = 51; suprarenal abdominal aorta, n = 24; infrarenal abdominal aorta, n = 3; and iliac artery, n = 2). The growth rate of each segment was obtained on CT. The factors influencing increase in the diameter and growth rate--age, sex, diabetes mellitus, atherosclerotic disease, history of smoking 20 years, chronic renal failure, blood pressure, initial diameter of the lumen, the presence of blood flow in the false lumen--were evaluated by univariate analysis and a multivariate logistic regression model.
Results:
Twenty (37.0%) of 54 patients had one or more segments that increased in size during the follow-up period. Of a total of 127 segments, 35 (27.6%) increased in size, and for all, the mean growth rate was -0.5 +/- 2.9 mm/year. This negative growth rate represents shrinkage. The mean growth rates within the first year and after 1 year from onset were -2.2 +/- 5.7 and 0.4 +/- 3.2 mm/year, respectively, and a significant difference was observed between them (p < 0.0001). An initial diameter of 40 mm or greater and the presence of blood flow in the false lumen were significant risk factors for an increase in the diameter, as confirmed by univariate and multivariate analyses.
Conclusion:
In patients with type B intramural hematoma, the affected aortas did not show a high incidence of enlargement during the follow-up period, but the affected aortas tended to increase in size after 1 year from onset. An initial diameter of 40 mm or greater and the presence of blood flow in the false lumen were important risk factors for enlargement during the follow-up period.
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