Abstract 13593: Detection of Intimal Tear by 64-row Multidetector Computed Tomography in Patients With Initially Diagnosed Acute Aortic Intramural Hematoma
Background: Aortic intramural hematoma (IMH) has been recognized as primarily caused by aortic wall hematoma without intimal tear or flow communication between true and false lumen. However, complete identification of intimal tear without flow communication in the entire aorta has not been possible with recent imaging modalities. The study purpose was to investigate whether intimal tear was detectable or not on 64-row multidetector computed tomography (MDCT).
Methods: We retrospectively studied 34 patients (age; 69±10 years, male/female; 21/34) who were admitted to our institution due to IMH within 48 hours from the onset, and underwent 64-row MDCT (VCT, GE medical systems, WI, USA) in acute phase. The data set was reconstructed with a slice thickness of 0.625mm or 1.2mm and longitudinally reconstructed images were obtained. We examined the existence of small ulceration, which suggested intimal tear or flow communication between true and false lumen, in the reconstructed longitudinal images in comparison with conventional axial images.
Results: There were 4 patients with Stanford type A, and 30 patients with Stanford type B IMH. MDCT was performed at 7.6±7.0 days from the onset. Although only 11 patients (32%) had been recognized as having intimal tear or ulcer-like projection with conventional axial CT images, small ulceration were pointed out in 25 patients (74%) with the longitudinally reconstructed images (p=0.0035). There were 38 lesions on MDCT; 0 in ascending aorta, 6 in aortic arch, 18 in proximal descending thoracic aorta, 14 in mid descending thoracic aorta, and 5 in distal descending thoracic aorta. The incidence of small ulceration was comparable in patients who underwent MDCT within 3 days from the onset, with those who underwent after 3 days (7 of 10 patients versus 18 of 24 patients, p=0.77).
Conclusions: MDCT is useful in detection of small ulceration in patients with initially diagnosed IMH. Even in very early stage, the incidence of small ulceration is considerably high. Our results may raise an issue about the genesis of “aortic intramural hematoma”.
- © 2010 by American Heart Association, Inc.