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European Radiology

, Volume 29, Issue 12, pp 6571–6580 | Cite as

Acute type B aortic intramural hematoma: the added prognostic value of a follow-up CT

  • Zhennan Li
  • Bin LuEmail author
  • Yuan Chen
  • Zhihui Hou
  • Baojin Chen
  • Yan Zhang
  • Yunqiang An
  • Yingjie Wei
Computed Tomography
  • 120 Downloads

Abstract

Objectives

To investigate prognostic significance of follow-up CT findings for initially medically treated type B aortic intramural hematoma (IMH).

Methods

We performed a retrospective pooled analysis of individual patient data, including baseline and follow-up CT characteristics. All enrolled patients were followed up for adverse aorta-related events, defined as a composite of aortic disease–related death and surgical or endovascular aortic repair.

Results

A total of 238 patients (73.9% men) were included, with a mean age of 58.1 ± 9.8 years. During follow-up, 83 patients (34.9%) experienced adverse aorta-related events, most of the events (83.1%) occurred within 1 month after follow-up CT imaging (n = 69). In the Cox regression model for predicting adverse aorta-related events, baseline maximal aortic diameter (MAD) (HR = 1.05, p = 0.008), ulcer-like projection (ULP) (HR = 2.47, p < 0.001), changes of maximal hematoma thickness (MHT) (HR = 1.22, p < 0.001), newly developed ULP (HR = 4.44, p < 0.001), and newly developed pleural effusion (HR = 2.46, p = 0.002) were powerful independent predictors. In combined predictive model for 1-month aortic events, baseline MHT ≥ 11.8 mm (OR = 4.39, p = 0.001), ULP (OR = 3.98, p < 0.001), changes of MHT (OR = 1.46, p < 0.001), newly developed ULP (OR = 9.27, p = 0.002), and newly developed pleural effusion (OR = 3.45, p = 0.015) were independent predictors. Besides, in patients with pleural effusion at baseline, resorption of pleural effusion was associated with adverse aorta-related events (HR = 0.36, p = 0.027) and 1-month aortic events (OR = 0.23, p = 0.026).

Conclusions

Follow-up CT findings provide strong and incremental prognostic information for initially medically treated type B IMH, which are helpful for risk estimates and decisions-making.

Key Points

• Follow-up CT provides strong and incremental prognostic information for initially medically treated type B aortic intramural hematoma.

• Follow-up CT is highly recommended for type B intramural hematoma in patients who did not receive urgent invasive therapy.

• Follow-up CT is helpful for risk estimates and decisions-making.

Keywords

Aortic diseases Hematoma Prognosis Computed tomography angiography 

Abbreviations

AAS

Acute aortic syndrome

BMI

Body mass index

CI

Confidence interval

CT

Computed tomography

HR

Hazard ratio

IBP

Intramural blood pool

IMH

Intramural hematoma

MAD

Maximal aortic diameter

MHT

Maximal hematoma thickness

OR

Odds ratio

ROC

Receiver operating characteristic

ULP

Ulcer-like projection

Notes

Acknowledgments

We thank the technician Lei Han for proofreading and we are grateful to Dr. Chuangshi Wang for statistical support.

Funding

The present study was supported by the Ministry of Science and Technology of China, National Key Research and Development Project (2016YFC1300400), and CAMS Innovation Fund for Medical Sciences (No. 2016-I2M-1-011).

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Bin Lu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Dr. Chuangshi Wang kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Zhennan Li
    • 1
  • Bin Lu
    • 1
    Email author
  • Yuan Chen
    • 1
  • Zhihui Hou
    • 1
  • Baojin Chen
    • 2
  • Yan Zhang
    • 3
  • Yunqiang An
    • 1
  • Yingjie Wei
    • 4
  1. 1.Department of Radiology, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China
  2. 2.Department of Radiology, Shandong Provincial HospitalShandong UniversityJinanPeople’s Republic of China
  3. 3.Department of RadiologyAffiliated Hospital of Guizhou Medical UniversityGuiyangPeople’s Republic of China
  4. 4.State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingPeople’s Republic of China

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