Related Experiment Videos
[Intramural hemorrhage of the thoracic aorta]
C Dieckmann1, Y von Kodolitsch, C R Habermann
1Radiologische Klinik, Abteilung Röntgendiagnostik.
Purpose:
Intramural hemorrhage (IMH) of the aorta is considered to be a possible preliminary stage to dissection. We report on our experience with MRI, CT, and TEE in the diagnosis as well as in the correct evaluation of the extent of an IMH.
Method:
Between 1983 and 1997 a total of 26 patients were examined using MRI (n = 13) and/or contrast enhanced CT (n = 18) or TEE. The validation was effected in 17 cases through intraoperative or postmortem inspection and in the remaining cases either through continuous clinical or radiological monitoring (n = 6) or through the depiction of the results in 2 different imaging procedures (n = 3).
Results:
The correct diagnosis of an IMH was made on all examined patients with all imaging modalities. In all cases, MRI enabled the correct identification of the affected aortic segments. Using CT the affected descending aorta was overlooked in one out of 15 cases; TEE failed in one out of two cases of intramural hemorrhage in the aortic arch. A false positive diagnosis was made with CT in one out of 9 cases in the ascending aorta, and using sonography, this occurred in two out of 3 cases in the area of the aortic arch.
Conclusion:
According to our experience, magnetic resonance imaging is the most accurate method for the diagnosis of an IMH.
Insights
Magnetic resonance imaging (MRI) is the most accurate method for diagnosing intramural hemorrhage (IMH) of the aorta. This study found MRI superior to CT and TEE in identifying IMH extent and location.
Area of Science:
- Cardiovascular Imaging
- Diagnostic Radiology
- Aortic Pathology
Background:
- Intramural hemorrhage (IMH) of the aorta is a critical condition potentially preceding aortic dissection.
- Accurate diagnosis and assessment of IMH extent are crucial for patient management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of MRI, CT, and transesophageal echocardiography (TEE) for IMH.
- To determine the most effective imaging modality for assessing the extent of IMH.
Main Methods:
- Retrospective analysis of 26 patients with suspected IMH between 1983 and 1997.
- Utilized MRI (n=13), contrast-enhanced CT (n=18), and TEE.
- Validation through intraoperative/postmortem inspection (n=17), clinical monitoring (n=6), or comparative imaging (n=3).
Main Results:
- All modalities correctly diagnosed IMH.
- MRI accurately identified affected aortic segments in all cases.
- CT missed one descending aorta IMH; TEE missed one aortic arch IMH. False positives occurred with CT and sonography.
Conclusions:
- MRI demonstrated the highest accuracy for diagnosing IMH.
- MRI is recommended as the preferred imaging modality for IMH evaluation.