title: Detection of intimal defect by 64-row multidetector computed tomography in patients with acute aortic intramural hematoma.
abstract: BACKGROUND
  Previous pathological and clinical studies demonstrated an intimal defect in patients with acute aortic intramural hematoma (IMH). The purpose of this study was to investigate the prevalence and clinical outcome of intimal defect detected by multidetector computed tomography (MDCT) in patients with IMH.
  
  
  RESULTS
  We retrospectively analyzed 38 consecutive patients with IMH in whom 64-row MDCT was performed during the acute phase (median, 5 days from the onset). Intimal defect was defined as continuity disruption of the inner layer of thrombosed false lumen, which could be detected by 1-mm axial and longitudinal interactive multiplanar reformation images. Clinical outcome of intimal defect was assessed in patients with type B IMH (n=32). A total of 48 lesions in 27 (71%) patients were recognized as intimal defects. The incidence of intimal defect was not affected by the timing of MDCT examination (1 to 3 days, 79%; 4 to 7 days, 58%; 8 to 14 days, 75%; P=0.56). In type B IMH, 16 (76%) of 21 patients with intimal defect showed progression (enlargement or progression to aortic aneurysm) in the chronic phase. In contrast, all 11 patients without intimal defect had complete resorption of hematoma. In lesion-based analysis, a depth of intimal defect of ≥ 5 mm predicted progression with sensitivity, specificity, and positive and negative predictive values of 84%, 95%, 94%, and 86%, respectively.
  
  
  CONCLUSIONS
  A considerable portion of patients with IMH showed intimal defect detected by MDCT even in the very early stage, and defects frequently enlarged. Patients with intimal defect should be carefully followed up with serial imaging.
authors.affiliation: Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kitai
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Kaji
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamamuro
authors.forename: Tomoko
authors.initials: T
authors.lastname: Tani
authors.forename: Makoto
authors.initials: M
authors.lastname: Kinoshita
authors.forename: Natsuhiko
authors.initials: N
authors.lastname: Ehara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kobori
authors.forename: Kitae
authors.initials: K
authors.lastname: Kim
authors.forename: Toru
authors.initials: T
authors.lastname: Kita
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*; D017539:Tunica Intima / Q000000981:diagnostic imaging*