title: Intramural blood pools accompanying aortic intramural hematoma: CT appearance and natural course.
abstract: OBJECTIVE
  To evaluate multidetector computed tomographic (CT) images to investigate the prevalence, morphology, natural course, and prognostic effect of intramural blood pools (IBPs) in patients with acute intramural hematoma (IMH).
  
  
  METHODS
  Institutional review board approval and written informed consent were obtained. Sixty-five patients (41 men; mean age, 65.9 years ± 11.3 [standard deviation]) with acute IMH undergoing three or more multidetector CT examinations during follow-up for 12 months or longer (median = 18 months), except for those undergoing surgery (n = 16), were enrolled. Associated factors of developing and resorption of IBP in IMH were analyzed by using logistic regression.
  
  
  RESULTS
  There were 40 IBPs in 10 patients at initial multidetector CT, and 15 new IBPs developed in 11 patients during follow-up. IBPs occurred most in the descending thoracic (55% [31 of 56]) and abdominal (41% [23 of 56]) aorta in 28% (18 of 65) of patients. During 33.8 months (range, 2.8-50 months) of follow-up in these 18 patients, 57% (32 of 56) of IBPs showed complete resorption in 15 patients, 29% (16 of 56) of IBPs showed incomplete resorption in eight patients, and 14% (eight of 56) of IBPs had interrupted follow-up because of surgery or death in three patients. Logistic regression showed that age younger than 70 years (odds ratio [OR], 8.74; 95% confidence interval [CI]: 1.03, 76.9) and IMH wall thickness greater than 10 mm (OR, 4.93; 95% CI: 1.04, 23.0) were associated with developing IBP at initial multidetector CT, while IBP with larger transmural diameter (OR, 1.16; 95% CI: 1.02, 1.31) and multidetector CT-demonstrated connection with intercostal or lumbar artery (63% [35 of 56]) (OR, 5.44; 95% CI: 1.43, 20.9) were associated with incomplete resorption.
  
  
  CONCLUSIONS
  IBPs are frequently observed at multidetector CT in patients with IMH. They may resolve over time or appear during follow-up. These findings are not associated with a poor prognosis, and IBPs should be distinguished from ulcerlike projections.
authors.affiliation: Department of Radiology, Section of Thoracic and Circulation Imaging, Division of Cardiovascular Surgery, Kaohsiung Veterans General Hospital, No. 386, Ta-Chung 1st Road, Kaohsiung 813, Taiwan. wu.mingting@gmail.com
authors.forename: Ming-Ting
authors.initials: MT
authors.lastname: Wu
authors.forename: Yen-Chi
authors.initials: YC
authors.lastname: Wang
authors.forename: Yi-Luan
authors.initials: YL
authors.lastname: Huang
authors.forename: Ruey-Sheng
authors.initials: RS
authors.lastname: Chang
authors.forename: Shang-Chieh
authors.initials: SC
authors.lastname: Li
authors.forename: Pinchen
authors.initials: P
authors.lastname: Yang
authors.forename: Tung-Ho
authors.initials: TH
authors.lastname: Wu
authors.forename: Kuan-Rau
authors.initials: KR
authors.lastname: Chiou
authors.forename: Jer-Shyung
authors.initials: JS
authors.lastname: Huang
authors.forename: Huei-Lung
authors.initials: HL
authors.lastname: Liang
authors.forename: Huey-Ben
authors.initials: HB
authors.lastname: Pan
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*