Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences and Peri-operative Sciences, Surgery, Umeå University, Umeå, Sweden.
Eur J Vasc Endovasc Surg. 2023 Sep;66(3):323-331. doi: 10.1016/j.ejvs.2023.05.039. Epub 2023 May 27.
The significance of the inflammatory response in the natural course of acute type B aortic dissection (ATBAD) is unknown. The aim was to characterise inflammation and its transformation over time in ATBAD using F-fluorodeoxyglucose (FDG) positron emission tomography (PET) with contrast enhanced magnetic resonance imaging (MRI).
Ten patients underwent FDG-PET/MRI within two weeks of ATBAD (acute phase), three to four months (subacute phase), nine to 12 months (early chronic phase), and 21 to 24 months (late chronic phase) after ATBAD. Target background ratios (TBRs) were measured in the ascending aorta, aortic arch, and descending aorta. MRI inflammatory markers were assessed in the descending aorta.
Ten patients were included: median age 69 years, median clinical follow up 32 months. In the acute phase there was increased FDG uptake in the descending aorta (maximum TBR 5.8, SD [standard deviation] 1.3) compared with the ascending aorta (TBR 3.3, SD 0.8, p < .010) and arch (TBR 4.2, SD 0.6, p = .010). The maximum TBR of the descending aorta decreased from the acute to subacute phase (TBR 3.5, SD 0.6, p = .010) and further to the early chronic phase (TBR 2.9, SD 0.4, p = .030) but was stable thereafter. The acute phase maximum TBR in the ascending aorta (TBR 3.3) and arch (TBR 4.2) decreased to the subacute phase (ascending: TBR 2.8, SD 0.6, p = .020; arch: TBR 2.7, SD 0.4, p = .010) and was stable thereafter. Four patients underwent surgical aortic repair (three for aortic dilatation at one, five, and 28 months and one for visceral ischaemia at three weeks). MRI signs of inflammation were present in all surgically treated patients vs. two of six of medically treated patients (p= .048).
ATBAD is associated with increased FDG uptake in the acute phase primarily in the descending aorta, but also involving the aortic arch and ascending aorta, indicating an inflammatory response in the whole aorta. Inflammation subsides early in the ascending aorta and arch (three months), whereas it stabilised later in the descending aorta (nine to 12 months). MRI signs of inflammation were more frequent in patients who later needed surgical treatment and merit further investigation.
急性 B 型主动脉夹层（ATBAD）自然病程中炎症反应的意义尚不清楚。本研究旨在使用 F-氟脱氧葡萄糖（FDG）正电子发射断层扫描（PET）联合对比增强磁共振成像（MRI），对 ATBAD 患者的炎症及其随时间的转化进行特征描述。
10 例患者在 ATBAD 后两周内（急性期）、3 至 4 个月（亚急性期）、9 至 12 个月（早期慢性期）和 21 至 24 个月（晚期慢性期）进行 FDG-PET/MRI 检查。测量升主动脉、主动脉弓和降主动脉的靶背景比（TBR）。在降主动脉评估 MRI 炎症标志物。
共纳入 10 例患者，中位年龄 69 岁，中位临床随访时间 32 个月。在急性期，降主动脉 FDG 摄取较升主动脉（TBR 3.3，SD 0.8，p<.010）和主动脉弓（TBR 4.2，SD 0.6，p=.010）增加（最大 TBR 5.8，SD 1.3）。降主动脉最大 TBR 从急性期到亚急性期（TBR 3.5，SD 0.6，p=.010）和早期慢性期（TBR 2.9，SD 0.4，p=.030）逐渐下降，但此后保持稳定。升主动脉（TBR 3.3）和主动脉弓（TBR 4.2）的急性期最大 TBR 下降至亚急性期（升主动脉：TBR 2.8，SD 0.6，p=.020；主动脉弓：TBR 2.7，SD 0.4，p=.010），此后保持稳定。4 例患者接受了主动脉手术修复（3 例因 1、5 和 28 个月时主动脉扩张，1 例因 3 周时内脏缺血而手术）。与 6 例接受药物治疗的患者中的 2 例相比，所有接受手术治疗的患者均存在 MRI 炎症表现（p=.048）。
ATBAD 急性期主要在降主动脉伴有 FDG 摄取增加，也累及主动脉弓和升主动脉，表明整个主动脉存在炎症反应。升主动脉和主动脉弓的炎症在 3 个月（亚急性期）早期消退，而降主动脉在 9 至 12 个月（早期慢性期）稳定下来。随后需要手术治疗的患者 MRI 炎症表现更为频繁，值得进一步研究。
