Clinical importance of minimal enhancement of type B intramural hematoma of the aorta on computed tomography imaging Eijun Sueyoshi, MD, Hironori Onizuka,

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Presentation transcript:

Clinical importance of minimal enhancement of type B intramural hematoma of the aorta on computed tomography imaging Eijun Sueyoshi, MD, Hironori Onizuka, MD, Hiroki Nagayama, MD, Ichiro Sakamoto, MD, Masataka Uetani, MD Journal of Vascular Surgery Volume 65, Issue 1, Pages 30-39 (January 2017) DOI: 10.1016/j.jvs.2016.06.117 Copyright © 2016 Terms and Conditions

Fig 1 Initial multidetector computed tomography (MDCT) images of an 82-year-old man with type B intramural hematoma of the aorta (IMH). Attenuation of the false lumen (AFL) was determined by manually placing circular or ovoid regions of interest on thrombus in the false lumen at the same locations on z-axis sections and at the same image level on nonenhanced (A), arterial phase contrast-enhanced (B), and delayed phase contrast-enhanced images (C), which were simultaneously displayed in a side-by-side fashion. Journal of Vascular Surgery 2017 65, 30-39DOI: (10.1016/j.jvs.2016.06.117) Copyright © 2016 Terms and Conditions

Fig 2 A, Box-and-whisker plots show the relationships and mean attenuation of the false lumen (AFL) of all patients on precontrast computed tomography (CT) scan (56.3 ± 10.5 Hounsfield units [HU]), arterial contrast-enhanced CT (59.9 ± 10.8 HU), and delayed contrast-enhanced CT (63.7 ± 11.1 HU). B, Bar graph shows displaying the distribution of enhancement of the false lumen (EFL) in the 65 patients. Journal of Vascular Surgery 2017 65, 30-39DOI: (10.1016/j.jvs.2016.06.117) Copyright © 2016 Terms and Conditions

Fig 3 Multidetector computed tomography (MDCT) images of a 75-year-old man with type B intramural hematoma of the aorta (IMH). The attenuation of the false lumen (AFL) on plain computed tomography (CT) scan, arterial phase contrast-enhanced CT, and delayed phase contrast-enhanced CT was 56, 57, and 57 Hounsfield units (HU), respectively. The enhancement of the false lumen (EFL) was 1 HU. A, At the onset, precontrast-enhanced CT shows a crescentic high attenuation area along the aortic wall. Arterial phase (B) and delayed phase (C) contrast-enhanced CT reveal a crescentic area without apparent contrast enhancement. D, Three months later, contrast-enhanced CT shows resolution of IMH. Journal of Vascular Surgery 2017 65, 30-39DOI: (10.1016/j.jvs.2016.06.117) Copyright © 2016 Terms and Conditions

Fig 4 Multidetector computed tomography (MDCT) images of a 73-year-old man with type B intramural hematoma of the aorta (IMH). The attenuation of the false lumen (AFL) on plain computed tomography (CT) scan, arterial phase contrast-enhanced CT and delayed phase contrast-enhanced CT was 58, 59, and 59 HU, respectively. The enhancement of the false lumen (EFL) was 1 HU. At the onset, arterial phase contrast-enhanced axial (A) and coronal (B) CT scans demonstrate an IBP (arrowhead) with distal connection to the intercostal artery (arrows). C, Three months later, contrast-enhanced CT shows that the IBP has disappeared and IMH has decreased. Journal of Vascular Surgery 2017 65, 30-39DOI: (10.1016/j.jvs.2016.06.117) Copyright © 2016 Terms and Conditions

Fig 5 Multidetector computed tomography (MDCT) images of a 74-year-old man with type B intramural hematoma of the aorta (IMH). The attenuation of the false lumen (AFL) for plain computed tomography (CT) scan, arterial phase contrast-enhanced CT, and delayed phase contrast-enhanced CT was 55, 59, and 68 HU, respectively. The enhancement of the false lumen (EFL) is 13 HU. A, At the onset, arterial phase contrast-enhanced coronal CT scan shows an intimal defect (arrow) with a depth of 1 mm. B, One month later, contrast-enhanced coronal CT scan reveals that the intimal defect has progressed to an ulcer-like projection (ULP; arrow) with a depth of 7 mm. C, Three months later, contrast-enhanced coronal CT scan demonstrates progressive enlargement of the ULP (arrow). After that, stent-graft placement was performed. D, After stent-graft placement, contrast-enhanced coronal CT scan shows disappearance of the ULP. Journal of Vascular Surgery 2017 65, 30-39DOI: (10.1016/j.jvs.2016.06.117) Copyright © 2016 Terms and Conditions