ABSTRACT
Objectives To investigate the morphologic characteristics of intramural hematoma (IMH) on CT angiography (CTA), and evaluate the possible correlation of serum C-reactive protein (CRP) with morphologic characteristics of IMH. Material and Methods Forty-two patients who were initially diagnosed as IMH by aortic CTA and also had serum CRP examination on the same day of CTA were enrolled in this retrospective study, including 30 males and 12 females, with the mean age of 61 ± 14 years old. The volumetric CT data were retrospectively processed and analyzed on post-processing workstation. Based on the thickness of IMH and the length-area curve, the cross-sectional area of true lumen and total vessel were measured, the hematoma-vessel ratio (HVR) was calculated. Imaging characteristics were compared between patients who had pathological elevated CRP (> 0.8 mg/dl) and those did not. Spearman correlation analyses of CRP level and morphological characteristics of IMH were performed, and the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic validity of CRP. Results Of all 42 IMH patients, the mean serum CRP was 3.94 ± 4.71 mg/dl, and the mean HVR was 46.7%± 14.2%. HVR in patients with elevated CRP was significantly higher than those with normal CRP (49.7% ± 15.0% vs. 40.7% ± 10.5 %, P = 0.030). HVR was mildly correlated with CRP in all patients (r =0.48, P < 0.001). CRP levels differed neither between patients with Stanford type A and B (P = 0.207), nor between patients with and without intimal disruption (P = 0.230). To discriminate HVR > 47% (the mean value), the area under curve (AUC) were 0.700 (95% CI: 0.535-0.865) for CRP at a cutoff point of 3.55 mg/dl, with a sensitivity of 54.5% and a specificity of 90.0%. Conclusion CRP was mildly correlated with the severity of cross-sectional hematoma area of IMH, but not with Stanford types and the presence of intimal disruption.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Aorta/pathology , C-Reactive Protein/metabolism , Computed Tomography Angiography , Hematoma/diagnostic imaging , Image Processing, Computer-Assisted , ROC Curve , Statistics, NonparametricABSTRACT
<p><b>OBJECTIVE</b>To assess the value of preoperative coronary computed tomographic angiography (CCTA) in the detection of coronary artery disease (CAD) in patients planned to undergo non-cardiac surgery at intermediate or high risk to avoid unnecessary invasive coronary angiography (ICA).</p><p><b>METHODS</b>The study protocol was approved by our institutional review board and informed consent was given. In this prospective study, 157 consecutive patients who underwent CCTA before undergoing non-cardiac surgery at intermediate or high risk was involved. The non-cardiac surgery included high-risk surgery (17 patients) and intermediate-risk surgery (140 patients). Follow-up was performed in 6-11 months to define cardiac events described as acute coronary syndrome (ACS) or death secondary to ASC, arrhythmias, cardiac revascularization, or cardiac failure. χ(2) test was performed to compare the differences in incidence of cardiac events among patients who had undergone or who had not undergone preoperative ICA.</p><p><b>RESULTS</b>CCTA was of diagnostic value in 145 of 157 patients. Thirty-seven of 145 had no CAD, and 88 of 145 had no significant CAD (<50% stenosis), and non-cardiac surgery was performed in them without preoperative ICA. No patients in those patients had postoperative ischemic events at follow-up; 20 had significant CAD (≥50% stenosis) and underwent surgery after preoperative ICA. CCTA was non-diagnostic in 12 patients who were referred for preoperative ICA, and 4 of 12 underwent surgery after PCI or CABG. There were no differences in cardiac events between patients who had undergone preoperative ICA and those who had not (P=0.45).</p><p><b>CONCLUSIONS</b>In patients with planned non-cardiac surgery at medium or high risk of cardiovascular events, preoperative CCTA is an effective diagnostic tool for detecting CAD. Preoperative ICA can be safely avoided in patients with normal findings or with stenosis<50% in CCTA.</p>