title: Type B intramural hematoma of the aorta: evolution and prognostic value of intimal erosion.
abstract: OBJECTIVE
  The prognosis and treatment of type B intramural hematoma (IMH) remain unclear. Intimal erosions could be the target of preventive endovascular treatment, but we have no therapeutic criterion on which to decide preventive treatment.
  
  
  METHODS
  A prospective multislice computed tomography (CT) study was carried out in 44 patients with type B IMH to assess morphologic evolution and intimal erosion to determine reliable predictive factors that would permit endovascular treatment. Follow-up range was 24-1,440 days.
  
  
  RESULTS
  Intimal anomalies consisted of intimal erosion and aortic branch artery lesions. Fifty-eight intimal anomalies were seen on initial CT in 38 patients (86%). Twenty-five anomalies in 22 patients were considered as intimal erosions, of which nine (36%) were visible only on delayed-phase CT. Hematoma regressed in 23 patients (53%). Twenty-one patients (47%) showed morphologic progression. Eleven of these (52%) required endovascular treatment. Twenty of the 25 initial intimal erosions (80%) progressed and caused 19 of the 21 morphologic evolutions (90%). Progression was related to initial intimal erosion and to IMH thickness. Intimal erosion measuring greater than 10 mm had unfavorable progression at 1 month (positive predictive value, 100%).
  
  
  CONCLUSIONS
  Complications or morphologic progression were related to a preexisting intimal anomaly visualized on initial CT. Multislice CT with systematically delayed phase and millimetric thin slices could increase the detection rate of intimal anomalies.
authors.affiliation: Department of Interventional Radiology, Centre Hospitalier Universitaire, Hôpital de Rangueil, Toulouse, France. schlatter.t@chu-toulouse.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Schlatter
authors.forename: Julien
authors.initials: J
authors.lastname: Auriol
authors.forename: Bertrand
authors.initials: B
authors.lastname: Marcheix
authors.forename: Mehdi
authors.initials: M
authors.lastname: Lebbadi
authors.forename: Marie Agnès
authors.initials: MA
authors.lastname: Marachet
authors.forename: Kim Diêp
authors.initials: KD
authors.lastname: Dang-Tran
authors.forename: Minhhoang
authors.initials: M
authors.lastname: Tran
authors.forename: Benjamin
authors.initials: B
authors.lastname: Honton
authors.forename: Virginie
authors.initials: V
authors.lastname: Gardette
authors.forename: Hervé
authors.initials: H
authors.lastname: Rousseau
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation; D016009:Chi-Square Distribution; D018450:Disease Progression; D057510:Endovascular Procedures; D005260:Female; D005602:France; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D017539:Tunica Intima / Q000000981:diagnostic imaging* / Q000601:surgery