Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Predictive Value of 18F-FDG PET/CT in Patients with Acute Type B Aortic Intramural Hematoma *Fan Yang, MD, *Jianfang Luo, MD, †Qingyi Hou, MD, *Nianjin Xie, MD, ‡Zhiqiang Nie, MD, *Wenhui Huang, MD, *Yuan Liu, MD, *Yingling Zhou, MD, *Jiyan Chen, MD, *Qingshan Geng, MD. Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangzhou, China (symbol as *) Department of PET Center, Guangdong General Hospital,Guangdong, China (symbol as †) Department of Epidemiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China (symbol as ‡) Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND 1- Acute intramural hematoma (IMH) is an important disease entity of acute aortic syndrome (AAS). 2- The clinical course and predictors of adverse aortic events (AAE) in patients with acute Stanford type B intramural hematoma (IMH) remain controversial. 3- Ulcer-like projection (ULP) has been considered as a prognostic factor of progression of type B IMH. 4- There are limited data on the application of 18F-FDG PET/CT to assess AAE in AAS. 5- The aim of this study therefore was to determine the prognostic value of 18F-FDG-PET/CT imaging in patients with type B IMH. Copyright American Society of Nuclear Cardiology

METHODS Study type:(Select all that apply) Study subjects: Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study type:(Select all that apply) Prospective and observational cohort. Study subjects: Patients with acute type B IMH who underwent PET/CT within 14 days from the onset of symptoms. Copyright American Society of Nuclear Cardiology

METHODS Study endpoints: Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study endpoints: Conversion to TEVAR (clinical and/or morphologic deterioration); Development of AD with intimal flap (classic or localized); Enlargement of initial ULP; Newly developed ULP; Aortic enlargement (≥50mm or increased by 25%). Copyright American Society of Nuclear Cardiology

METHODS Study variables Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study variables Patient Characteristics (Basic characteristics, Complication, Medicine therapy); Laboratory variables (D2-dimer, C-reactive protein); Morphologic variables (Initial ULP, Maximum aortic diameter); Metabolic variables (SUVmax, SUVsuperior vena cava, target to blood ratio,TBR). Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS Figure 1. Two representative cases of patients with ULP. Left panel, a 55-y-old man with greater uptake of 18F-FDG in the aortic wall: A, ULP (arrow) were detected at the middle descending aorta in initial CTA; B-C, accumulation of 18F-FDG in the aortic wall in PET/CT (arrow), the SUVmax and TBR were 4.8 and 1.3, respectively; D, ULP progressed to classic aortic dissection (arrow) 1 mo after onset. Right panel, a 52-y-old man with low uptake of 18F-FDG in the aortic wall: E, ULP (arrow) were detected at the proximal descending aorta in initial CTA; F-G, no obvious accumulation of 18F-FDG in the aortic wall on PET/CT, the SUVmax and TBRwere 2.7 and 1.1, respectively; H, ULP had no change 35 days after onset. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS 1- Patients with ULP who exhibited a greater uptake of 18F-FDG in the aortic wall were more likely to develop adverse aortic events. 2- More careful surveillance with serial imaging is recommended for high-risk patients. 3- It is also important to conduct studies investigating the efficacy of endovascular treatment for high-risk patients with ULP. Copyright American Society of Nuclear Cardiology