Proposed Magnetic Resonance Imaging Criteria to Diagnose Intramural Haematoma and to Predict Aortic Healing after Acute Type B Aortic Syndrome

Adeline Schwein, Mohammad Khan, Matthew Bennett, Nabil Chakfé, Alan B. Lumsden, Jean Bismuth, Dipan J. Shah

Research output: Contribution to journalArticle

1 Scopus citations

Abstract

Objective: Type B acute aortic syndrome (AAS) encompasses aortic dissection (AD) and intramural haematoma (IMH), the diagnosis, evolution, and treatment of which are subject to controversies. The aim of this pilot investigation was to assess the ability of specific magnetic resonance imaging (MRI) criteria to differentiate AD from IMH and predict optimal aortic remodeling following AAS. Methods: In this retrospective study, all patients presenting between 2008 and 2015 with type B AAS, who had diagnostic MRI following admission, were included. Three MRI criteria were proposed to identify IMH: (i) no visualised entry tear; (ii) no contrast uptake in the aortic lesion on the first pass angiographic run; (iii) no contrast uptake in the aortic lesion on the equilibrium phase T1 sequence. On each patient's diagnostic and follow up imaging studies, the volume of (i) false lumen/IMH, (ii) total aorta, and (iii) true lumen were calculated. Using the Wilcoxon signed rank test, the evolution of these volumes according to the presence or absence of the aforementioned criteria were compared. Results: Of 39 patients, in seven all MRI criteria were positive (group IMH) and 32 had one or more negative criteria (group AD). Patients with IMH and AD were similar with respect to sex, age, and delay between onset of symptoms and diagnostic and follow up imaging studies. Eighteen patients had a follow up imaging study after a mean period of 11.2 months: six in the IMH group and 12 in the AD group. Lesion volume decrease and relative true lumen volume increase were statistically significant in group IMH (p =.046 and p =.046, respectively), whereas there was a statistically significant increase of lesion volume (p =.008) in the AD group. Conclusion: This pilot study proposed three simple MRI criteria to differentiate between AD and IMH. Once prospectively and clinically validated, this could have substantial therapeutic benefits as IMH are likely to heal spontaneously.

Original languageEnglish (US)
Pages (from-to)350-359
Number of pages10
JournalEuropean Journal of Vascular and Endovascular Surgery
Volume57
Issue number3
DOIs
StatePublished - Mar 2019

Keywords

  • Acute aortic syndrome
  • Aortic dissection
  • Aortic remodeling
  • Intramural haematoma
  • Magnetic resonance imaging

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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