The Third Clinical College of Xinxiang Medical University, Xinxiang, China.
Department of Radiology, The Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.
BMC Cardiovasc Disord. 2023 Jul 28;23(1):378. doi: 10.1186/s12872-023-03413-6.
Intramural hematoma (IMH) and Aortic dissection (AD) have overlapping features. The aim of this study was to explore the differences between them by comparing the clinical manifestations and imaging features of patients with acute Stanford type B IMH-like lesions and acute Stanford type B AD (ATBAD).
This study retrospectively analysed the clinical and computed tomography angiography (CTA) imaging data of 42 IMH-like lesions patients with ulcer-like projection (ULP) and 38 ATBAD patients, and compared their clinical and imaging features.
(1) The IMH-like lesions patients were older than the ATBAD patients (64.2 ± 11.5 vs. 50.9 ± 12.2 years, P < 0.001). The D-dimer level in the IMH-like lesions group was significantly higher than that in the ATBAD group (11.2 ± 3.6 vs. 9.2 ± 4.5 mg/L, P < 0.05). The incidence rate of back pain was significantly higher in the ATBAD group than in the IMH-like lesions group (71.1% vs. 26.2%, P < 0.05). (2) The ULPs of IMH-like lesions and the intimal tears of ATBAD were concentrated in zone 4 of the descending thoracic aorta. The ULPs of IMH-like lesions and the intimal tears of ATBAD were mainly in the upper quadrant outside the lumen (64.3% vs. 65.8%, P > 0.05). (3) The maximum diameter of the ULPs in IMH-like lesions was smaller than that of the intimal tears in ATBAD (7.4 ± 3.4 vs. 10.8 ± 6.8 mm, P = 0.005). The lumen compression ratio in the ULPs plane and the maximum compression ratio of the aortic lumen in the IMH-like lesions group were smaller than that in the ADBAD group (P < 0.05). Fewer aortic segments were involved in IMH-like lesions patients than in ATBAD patients (5.6 ± 2.2 vs. 7.1 ± 1.9 segments, P < 0.005). The IMH-like lesions group had less branch involvement than that of the ATBAD group (P < 0.001).
The degree of intimal tears, lumen compression ratio, extent of lesion involvement, and impact on branch arteries in ATBAD are more severe than that of IMH-like lesions. But for the ULPs of IMH-like lesions and intimal tears of ATBAD, they have astonishing similarities in the location of the partition and the lumen quadrant, we have reason to believe that intimal tear is the initial factor in the pathogenesis of this kind of disease, and their clinical and imaging manifestations overlap, but the severity is different. Concerning similarities between these two conditions, these two may be a spectrum of one disease.
壁内血肿（IMH）和主动脉夹层（AD）有重叠的特征。本研究旨在通过比较急性 Stanford 型 B 型 IMH 样病变和急性 Stanford 型 B 型 AD（ATBAD）患者的临床表现和影像学特征，探讨两者之间的差异。
本研究回顾性分析了 42 例具有溃疡样突起（ULP）的急性 Stanford 型 B 型 IMH 样病变患者和 38 例急性 Stanford 型 B 型 AD（ATBAD）患者的临床和计算机断层血管造影（CTA）影像学资料，并比较了其临床和影像学特征。
（1）IMH 样病变患者比 ATBAD 患者年龄大（64.2±11.5 岁 vs. 50.9±12.2 岁，P<0.001）。IMH 样病变组的 D-二聚体水平明显高于 ATBAD 组（11.2±3.6 vs. 9.2±4.5 mg/L，P<0.05）。ATBAD 组的背痛发生率明显高于 IMH 样病变组（71.1% vs. 26.2%，P<0.05）。（2）IMH 样病变的 ULP 和 ATBAD 的内膜撕裂主要集中在降主动脉 4 区。IMH 样病变的 ULP 和 ATBAD 的内膜撕裂主要位于管腔外上象限（64.3% vs. 65.8%，P>0.05）。（3）IMH 样病变 ULP 的最大直径小于 ATBAD 的内膜撕裂（7.4±3.4 vs. 10.8±6.8 mm，P=0.005）。在 ULP 平面的管腔压缩比和 IMH 样病变组主动脉管腔的最大压缩比均小于 ATBAD 组（P<0.05）。IMH 样病变患者受累的主动脉节段少于 ATBAD 患者（5.6±2.2 节 vs. 7.1±1.9 节，P<0.005）。IMH 样病变组分支受累少于 ATBAD 组（P<0.001）。
ATBAD 的内膜撕裂程度、管腔压缩比、病变受累程度和分支动脉受累程度均比 IMH 样病变严重。但对于 IMH 样病变的 ULP 和 ATBAD 的内膜撕裂，它们在分隔和管腔象限的位置上有惊人的相似之处，我们有理由相信内膜撕裂是这种疾病发病机制的初始因素，它们的临床表现和影像学表现重叠，但严重程度不同。鉴于这两种情况的相似性，这两种情况可能是同一种疾病的一个谱。
