Detection of the intimal tear in aortic dissection and ulcer-like projection in intramural hematoma: usefulness of full-phase retrospective ECG-gated CT angiography

Satoru Yanagaki,Masatoshi Kojima,Hideki Ota,Atsuro Masuda,Wahei Mihara,Takuya Ueda,Kei Takase,Yuta Onaka,Takashi Hattori

doi:10.1007/s11604-020-01008-1

Satoru Yanagaki, Masatoshi Kojima + Show 7 more

Open Access

https://doi.org/10.1007/s11604-020-01008-1

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Abstract

PurposeTo compare the accuracy of non-electrocardiogram (ECG)-gated CT angiography (CTA), single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA in detecting the intimal tear (IT) in aortic dissection (AD) and ulcer-like projection (ULP) in intramural hematoma (IMH).Materials and methodsA total of 81 consecutive patients with AD and IMH of the thoracic aorta were included in this single-center retrospective study. Non-ECG-gated CTA, single-diastolic-phase ECG-gated CTA, and full-phase ECG-gated CTA were used to detect the presence of the IT and ULP in thoracic aortic regions including the ascending aorta, aortic arch, and proximal and distal descending aorta.ResultsThe accuracy of detecting the IT and ULP was significantly greater using full-phase ECG-gated CTA (88% [95% CI: 100%, 75%]) than non-ECG-gated CTA (72% [95% CI: 90%, 54%], P = 0.001) and single-diastolic-phase ECG-gated CTA (76% [95% CI: 93%, 60%], P = 0.008).ConclusionFull-phase ECG-gated CTA is more accurate in detecting the IT in AD and ULP in IMH, than non-ECG-gated CTA and single-diastolic-phase ECG-gated CTA.

Highlights

Aortic dissection (AD) is a life-threatening disease with an estimated incidence of six to 10 cases per 100,000 persons per year and a mortality rate of 25–30% [1, 2].Recent guidelines for AD have emphasized the importance of detecting the intimal tear (IT) including entry/ re-entry in AD and ulcer-like projection (ULP) in intramural hematoma (IMH) [3,4,5]
Our study revealed that full-phase retrospective ECG-gated CT angiography (CTA) was more accurate in detecting the IT in AD and ULP in IMH than non-ECG-gated CTA and single-diastolic-phase ECG-gated CTA
Our study showed that full-phase retrospective ECG-gated CTA had a greater accuracy in detecting the IT in AD and ULP in IMH than non-ECG-gated CTA and single-diastolic-phase ECG-gated CTA

Summary

Introduction

Aortic dissection (AD) is a life-threatening disease with an estimated incidence of six to 10 cases per 100,000 persons per year and a mortality rate of 25–30% [1, 2].Recent guidelines for AD have emphasized the importance of detecting the intimal tear (IT) including entry/ re-entry in AD and ulcer-like projection (ULP) in intramural hematoma (IMH) [3,4,5]. Several researches emphasize the importance of detection of IT of AD at initial surgery, which is significant findings to determine indication of aortic arch replacement rather than simple ascending aortic replacement as it is a significant risk factor for reoperation [6, 7]. The presence of ULP in IMH is a significant factor in determining the surgical indication of complicated IMH [8,9,10]. It is crucial to accurately detect the IT in AD and ULP in IMH. Following such change in the treatment strategies, the clinical significance to

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