Differences in Aortic Intramural Hematoma Contrast Attenuation on Multi-Phase CTA Predict Long-Term Aortic Morphologic Change.
Journal
Annals of vascular surgery
ISSN: 1615-5947
Titre abrégé: Ann Vasc Surg
Pays: Netherlands
ID NLM: 8703941
Informations de publication
Date de publication:
Nov 2022
Nov 2022
Historique:
received:
25
02
2022
revised:
10
05
2022
accepted:
11
05
2022
pubmed:
7
6
2022
medline:
25
2
2023
entrez:
6
6
2022
Statut:
ppublish
Résumé
Evolution of aortic intramural hematoma (IMH) over time may range from resolution to degeneration and is difficult to predict. We sought to measure differences in contrast attenuation between arterial and delayed phase computed tomography angiography (CTA) images within the IMH as a surrogate of hematoma blood flow to predict resolution versus aortic growth and/or adverse outcomes. IMH institutional data were gathered from 2005-2020. Hounsfield unit ratio (HUR) was measured as hematoma Hounsfield unit (HU), on delayed phase images divided by HU on arterial phase images on CTA. Aortic growth and effect of HUR was determined using a linear mixed effects model. Freedom from adverse aortic event, defined as the composite of intervention, recurrence of symptoms, radiographic progression, and rupture, was determined using Kaplan-Meier analysis. IMH occurred in 73 patients, of which 27 met the inclusion criteria. HUR ranged from 0.38-1.92 (mean: 0.98). Baseline aortic diameter growth independent of HUR measurement was 0.49 mm/year (95% confidence interval CI: -1.23 to 2.2). With the HUR was introduced into the model, the beta coefficient for time was -5.83 mm/year (95% CI: -10.4 to -1.28 mm/year) and the beta coefficient for the HUR was 5.05 mm/year per one-unit HUR (95% CI: 0.56 to 9.56 mm/year). Thus, an HUR>1.15 would correspond to aortic growth while an HUR<1.15 would correspond to reduction in aortic diameter, consistent with IMH resolution. Aortic adverse events occurred in 13 (48%) patients, 7 (26%) patients had recurrence of symptoms, 8 (30%) required intervention, 5 (18%) progressed to dissection, and 1(4%) had aortic rupture. There was a trend towards an association between higher HUR and composite adverse aortic events (HR 3.2 per 1-unit HUR; 95% CI: 0.6-17.3; P = 0.18). Increased HUR is associated with increased aortic growth and a trend toward adverse aortic events. Diminished delayed phase enhancement may predict partial or complete IMH resolution. HUR can be used to guide IMH surveillance and treatment.
Sections du résumé
BACKGROUND
BACKGROUND
Evolution of aortic intramural hematoma (IMH) over time may range from resolution to degeneration and is difficult to predict. We sought to measure differences in contrast attenuation between arterial and delayed phase computed tomography angiography (CTA) images within the IMH as a surrogate of hematoma blood flow to predict resolution versus aortic growth and/or adverse outcomes.
METHODS
METHODS
IMH institutional data were gathered from 2005-2020. Hounsfield unit ratio (HUR) was measured as hematoma Hounsfield unit (HU), on delayed phase images divided by HU on arterial phase images on CTA. Aortic growth and effect of HUR was determined using a linear mixed effects model. Freedom from adverse aortic event, defined as the composite of intervention, recurrence of symptoms, radiographic progression, and rupture, was determined using Kaplan-Meier analysis.
RESULTS
RESULTS
IMH occurred in 73 patients, of which 27 met the inclusion criteria. HUR ranged from 0.38-1.92 (mean: 0.98). Baseline aortic diameter growth independent of HUR measurement was 0.49 mm/year (95% confidence interval CI: -1.23 to 2.2). With the HUR was introduced into the model, the beta coefficient for time was -5.83 mm/year (95% CI: -10.4 to -1.28 mm/year) and the beta coefficient for the HUR was 5.05 mm/year per one-unit HUR (95% CI: 0.56 to 9.56 mm/year). Thus, an HUR>1.15 would correspond to aortic growth while an HUR<1.15 would correspond to reduction in aortic diameter, consistent with IMH resolution. Aortic adverse events occurred in 13 (48%) patients, 7 (26%) patients had recurrence of symptoms, 8 (30%) required intervention, 5 (18%) progressed to dissection, and 1(4%) had aortic rupture. There was a trend towards an association between higher HUR and composite adverse aortic events (HR 3.2 per 1-unit HUR; 95% CI: 0.6-17.3; P = 0.18).
CONCLUSIONS
CONCLUSIONS
Increased HUR is associated with increased aortic growth and a trend toward adverse aortic events. Diminished delayed phase enhancement may predict partial or complete IMH resolution. HUR can be used to guide IMH surveillance and treatment.
Identifiants
pubmed: 35659917
pii: S0890-5096(22)00251-5
doi: 10.1016/j.avsg.2022.05.012
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
87-94Informations de copyright
Copyright © 2022 Elsevier Inc. All rights reserved.