| 최이령¹, 조현철¹,송재욱¹ ,이수진¹,장신이¹,성기익²,박표원²,최연현³,김덕경¹,최승혁¹ |
Background Aortic intramural hematoma (IMH) often comes with focal aortic dissection (AD). Most of studies had conventionally excluded IMH with focal AD. The aim of this study was to analyze novel predictive factors including focal AD and tortuosity and to investigate natural course of focal AD within type B IMH. Methods We retrospectively analyzed 74 patients with type B IMH by serial computed tomography (CT) images. To investigate the novel predictors of IMH progression, this study analyzed these following variables : age, sex, maximal thickness of the hematoma, maximal aortic diameter, ulcerlike projection(ULP), pleural effusion, calcification, severity of tortuosity and presence of focal AD on initial CT. Tortuosity was measured by specialized CT reconstruction program. We reviewed initial and follow-up CT images to identify natural course of focal AD within IMH. Result Reviewing of initial CT, there were the presence of ULP(n=33), focal AD (n=22), pleural effusion (n=16) and calcification (n=14). Fourteen patients (18.9 %) progressed to aortic aneurysm (n=10), classic AD(n=2), rupture(n=1), severe penetrating aortic ulcer(PAU)(n=1), progression to ascending aorta(n=1) during the follow-up period( 36±31 months). In a set of 9 variables, multivariate analysis revealed the maximum aortic diameter (42.9 ±7 with progression vs 37.4 ±6 mm with regression, p=0.024) and the presence of ULP(p=0.014) were significant predictor of progression of type B IMH. The presence of focal AD (p=0.372) and the severity of tortuosity (p= 0.954) were not associated with progression of type B IMH. At the end of follow-up, focal AD(n=22) within IMH on initial CT had complete regression(n=14, 63%), no change(n=2), aneurysmal change(n=3), slight increase of size(n=3). Conclusion The maximum aortic diameter and ULP on initial CT are the significant predictive factors for progression of type B IMH. Focal AD and severity of tortuosity can not be predictive for progression of IMH. Focal AD within type B IMH has a trend to regress on the long-term follow-up.
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