Detection of the intimal tear in aortic dissection and ulcer-like projection in intramural hematoma: usefulness of full-
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ORIGINAL ARTICLE
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 Yanagaki1 · Takuya Ueda1 · Atsuro Masuda1 · Hideki Ota1 · Yuta Onaka1 · Masatoshi Kojima2 · Takashi Hattori3 · Wahei Mihara3 · Kei Takase1 Received: 3 March 2020 / Accepted: 15 June 2020 © The Author(s) 2020
Abstract Purpose To 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 methods A 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. Results The 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). Conclusion Full-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. Keywords Aortic dissection · Intramural hematoma · Retrospective ECG-gated CTA · Intimal tear · Ulcer-like projection Abbreviations IT Intimal tear AD Aortic dissection ULP Ulcer-like projection IMH Intramural hematoma ECG Electrocardiogram
* Satoru Yanagaki [email protected] 1
Departments of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Seiryo 1‑1, Sendai 980‑8574, Japan
2
Department of Radiology, Seikeikai Chiba Medical Center, 1‑7‑1, Minami‑cho, Chuo‑ku, Chiba 260‑0842, Japan
3
Departments of Cardiovascular Surgery, Seikeikai Chiba Medical Center, 1‑7‑1, Minami‑cho, Chuo‑ku, Chiba 260‑0842, Japan
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) [3–5]. There are three reasons for this. First, 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]. Second, the presence of ULP in IMH is also a significant factor in determining the surgical indication of complicated IMH [8–10]. Third, in thoracic endovascular aortic repair, complet
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