Abstract 15259: Impact of Tissue Heterogeneity of Hematoma on the Development of Ulcer-like Projection in Patients With Acute Aortic Intramural Hematoma
Background: Ulcer-like Projection (ULP) has been currently recognized as a maker of progressive disease course in patients with acute aortic intramural hematoma (IMH). Although precise mechanism of ULP development is still unclear, micro flow via small intimal tear may be one of the causes. This study aimed to investigate whether computed tomography (CT) density values of thickened aortic wall could predict development of ULP.
Methods: We studied 35 patients (age; 72±11 years, male/female; 21/14) who were admitted to our institution due to IMH within 48 hours from the onset, and underwent serial 64-row multi-slice CT examinations. CT density values were assessed on admission within thickened aortic wall in each slice at aortic arch, proximal descending aorta, mid descending aorta, and distal descending aorta (Figure). We calculated heterogeneity index as standard deviation of CT values divided by mean values. Development of ULP, defined as a localized blood-filled pouch protruding into the thrombosed false lumen, was assessed by comparing the initial and follow-up CT within 30 days from the onset.
Results: The development of ULP was observed in 15 patients (43%), whereas 20 patients (57%) showed significant regression of thickened aortic wall. Patients who developed ULP had significantly higher heterogeneity index (0.36±0.11 vs 0.26±0.07, P=0.002), although there were no significant differences in mean CT values between patients with and without ULP (51.7 vs 53.1, P=0.69). Moreover, receiver-operating characteristic curve analysis identified CT heterogeneity index of 0.29 as a cut off for predicting ULP development (area under the curve, 0.79; 95% CI, 0.64-0.94, P=0.003) with sensitivity and specificity of 80% and 75%, respectively.
Conclusions: Evaluation of tissue heterogeneity of hematoma assessed by CT density values might be useful to predict disease progression in patients with IMH.
Author Disclosures: T. Kitai: None. S. Kaji: None. K. Kim: None. N. Ehara: None. A. Kobori: None. M. Kinoshita: None. T. Tani: None. Y. Furukawa: None.
- © 2014 by American Heart Association, Inc.