Imaging findings and clinical value of multiple-slice computed tomography angiography in acute aortic intramural hematoma

Objective To explore the imaging findings in and clinical value of multiple-slice computed tomography angiography (MSCTA) in acute aortic intramural hematoma (AAIH). Methods A total of 76 AAIH cases with complete clinical information were recruited and subjected to MSCTA examinations. The patients were divided into progressive and stable groups according to the follow-up changes. Then, the clinical data and MSCTA features were compared. All outcomes were analyzed statistically. The quantitative data of normal distribution and abnormal distribution were tested by two independent samples and Mann-Whitney U test, respectively. The qualitative data were tested by chi-square test. Results A total of 27 (35.5%) type A cases and 49 (64.5%) type B cases were classified according to Stanford criteria. No significant difference in the maximum thickness of aortic hematoma, number of ulcer-like projections, degree of focal enhancement, and severity of pleural effusion was noted between the Stanford A and B groups (Z=-0.788, χ2=0.441, χ2=0.383, χ2=0.338, all P>0.05). The ulcer depths in the Stanford A and B groups were (2.8 ± 2.9) and (2.5 ± 3.3) mm, respectively (Z=-2.345, P= 0.019). Meanwhile, 15 (19.7%) cases (12 type A cases and 3 type B cases) were accompanied by pericardial effusion (χ2=16.138, P 0.05). Multivariate analysis revealed that the amount of ulcer-like projections was the independent risk factor for AAIH progression. Conclusions AAIH manifested as annular and/or crescent thickening aortic wall with higher density in plain scan and non enhancement in enhanced scan using MSCTA technique. MSCTA plays an important role in the correct diagnosis of AAIH patients. The number of ulcer-like projections is the independent risk factor for disease progression. Close follow up is hence recommended during the early stage of AAIH using MSCTA. Key words: Aorta; Tomography, X-ray computed; Angiography; Intramural hematoma