1. 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 ‡)
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2. 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.
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3. 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.
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4. 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%).
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5. 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).
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6. Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology
RESULTS
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7. 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.
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8. 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.
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