The Clinical Value Of MSCTA For The Prognosis Of Aortic Intramural Hematoma

Objective：To investigate the clinical value of MSCTA for the prognosis of aorticintramural hematoma，and select the risk factors in the prognosis of aortic intramuralhematoma.Material and Methods：We retrospectively collected35patients who had beendiagnosed as aortic intramural hematoma on initial MSCTA during Jan2008and July2011, the interval ranged from6days to818days，average interval126days. Amongthese patients,31of them redid MSCTA after conservative management,2of themredid MSCTA after invention(stent implantation),and the remaining2of them didMRA for following-up after conservative management. We tried to find themanifestation of different prognosis of aortic intramural hematoma on33patients’per-after MSCTA images. Also8parameters of total35patients includingage,gender,complicating with or without atherosclerosis, Stanford classification,initial diameter of the affected aorta, the maximum thickness of the hematoma,complicating with or without penetrating aortic ulcer, complicating with or withoutlocated strengthening were recorded respectively. According to following-up medicalimaging examination(MSCTA or MRA) and clinical diagnosis, we estimatedprognosis, and carried out the Logistic multivariate regression for risk factorsanalysis.Result：33patients’ manifestations on MSCTA images showed different prognosis ofaortic intramural hematoma:13cases showed the hematoma absorbed or disappearedafter conservative management,which meaned the IMH regressed(39.4%),18casesshowed the hematoma progressed(54.5%),2cases showed the stents well-inflated,thehematoma absorbed or disappeared while no complication appeared after stentimplantation(6.1%).18patients showed some main manifestations of progression ofIMH on MSCTA images:①the increase of the thickness of the hematoma3 cases(16.7%);②the range extension of the hematoma1case(5.6%);③the enlargementof the aortic canal3cases(16.7%);④the expansion of PAU or/and recently-appearingPAU9cases(50%);⑤progression into dissection3case(16.7%);⑥recently-appearingactive blood leaking2cases(11.1%);⑦the increase of the blood leaking4cases(22.2%);⑧recently-appearing hydrothorax or the increase of the hydrothorax6cases(33.3%);⑨recently-appearing pericardial effusion or the increase of thepericardial effusion6cases(33.3%). After the Logistic multivariate regression, age,atherosclerosis, initial diameter of the affected aorta, the maximum thickness of thehematoma≥11mm, complicating with or without penetrating aortic ulcer,complicating were risk factors of prognosismala of aortic intramural hematoma.Conclusion:As the first noninvasive method to diagnosis intramural hematoma,MSCTA can not only provide theoretical basis for the clinical treatment of intramuralhematoma,but also effectively estimate its prognosis.