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Published on: June 2, 2015
Early Dynamic Changes in Haematoma Thickness in Medically Managed Type A Intramural Haematoma: A Multicentre
Yusuke Motoji1,2, Tadashi Kitamura3, Noritsugu Naito4
1Department of Cardiovascular Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara-shi, Kanagawa, 252-0374, Japan.
Summary
The maximum ascending aortic diameter (MAD) remodelling rate, not haematoma thickness (HT), independently predicts in-hospital disease progression in type A intramural haematoma (IMH). Early MAD assessment is crucial for risk stratification in IMH patients.
Area of Science:
- Cardiovascular Imaging
- Thoracic Surgery
- Vascular Medicine
Background:
- Type A intramural haematoma (IMH) is a variant of aortic dissection.
- Early identification of disease progression is critical for managing IMH.
- Haematoma thickness (HT) and maximum ascending aortic diameter (MAD) are key imaging parameters.
Purpose of the Study:
- To investigate early changes in HT and MAD after IMH onset.
- To assess the association between these parameters and in-hospital disease progression.
- To determine the predictive value of HT and MAD remodelling rates for adverse outcomes.
Main Methods:
- Retrospective analysis of 140 patients with type A IMH.
- Serial computed tomography angiography (CTA) scans were used to calculate remodelling rates (mm/h) for HT and MAD.
- In-hospital disease progression was defined by specific imaging and clinical events.
Main Results:
- In-hospital disease progression occurred in 25% of patients; mortality was 9%.
- Both HT and MAD showed rapid early negative remodelling.
- Only the MAD remodelling rate independently predicted in-hospital disease progression (OR 0.71; p=0.025).
Conclusions:
- Single-time-point HT measurement has limited utility for early risk stratification in type A IMH.
- Repeated early morphological assessment of MAD is valuable for selected medically managed IMH patients.
- MAD remodelling rate is a significant predictor of in-hospital disease progression.
