Published online Nov 28, 2018. doi: 10.4329/wjr.v10.i11.150
Peer-review started: April 30, 2018
First decision: June 14, 2018
Revised: August 30, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: November 28, 2018
The life-threatening condition of an intramural hematoma (IMH) is often missed on routinely performed contrast enhanced computed tomography (CT) angiographies (CTA) in patients with suspected acute aortic syndrome (AAS).
To optimize the CT protocol for AAS.
To assess the potential benefit of a CTA protocol that includes an additional unenhanced acquisition added to contrast-enhanced scans in the diagnostic pathway of patients with AAS.
Aortic CTA of patients with suspected AAS were retrospectively evaluated for acute aortic dissection, IMH, or penetrating aortic ulcer. The spiral CTA protocol consisted of an unenhanced acquisition and an arterial phase. If AAS was detected, a venous phase (delay, 90 s) was added. Images were evaluated for the presence and extent of aortic pathologies, and related complications.
23% of patients with AAS had an IMH. There was no significant difference in the involvement of the ascending aorta or the average age between dissection and IMH. Only the unenhanced acquisitions showed a significant density difference between the adjacent lumen and the IMH. Subadventitial hematoma involving the pulmonary trunk was present in five patients.
IMH is a common and difficult to detect entity of AAS. An additional unenhanced acquisition within an aortic CTA protocol facilitates the detection of IMH.
The results underline the importance of a triphasic CTA as standard diagnostic procedure in patients with suspected AAS.