uptake of f-fdg: new predictor for type b imh progression · uptake of 18f-fdg: new predictor for...
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![Page 1: Uptake of F-FDG: New Predictor for Type B IMH Progression · Uptake of 18F-FDG: New Predictor for Type B IMH Progression Jianfang Luo, MD FACC FESC Director, Vascular Center Guangdong](https://reader034.vdocument.in/reader034/viewer/2022042402/5f10cfca7e708231d44aeebb/html5/thumbnails/1.jpg)
Uptake of 18F-FDG: New Predictor
for Type B IMH Progression
Jianfang Luo, MD FACC FESC
Director, Vascular Center
Guangdong Cardiovascular Institute
Guangdong General Hospital
Guangzhou, China
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DisclosureSpeaker name:Jianfang Luo.
I have the following potential conflicts of interest to report:
Consulting
Employment in industry
Stockholder of a healthcare company
Owner of a healthcare company
Other(s)
I do not have any potential conflict of interest
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IMH develops in the media of the
aortic wall in the absence of an
false lumen and intimal tear.
Crescentic or circular aortic wall
thickening on CT>5 mm in the
absence of detectable blood
flow.
Intramural haematoma
(IMH)
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International Registry of
Aortic Dissection (IRAD)
Type B IMH 58%
In-hospital mortality was 4%
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Intramural hematomas with focal
areas of dissection demonstrated
80% and 40% 5- and 8-year
freedom from dissection-related
mortality
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Predictors of IMH
Complications
Persistent and recurrent pain despite
aggressive medical treatment1
Difficult blood pressure control2
Maximum aortic diameter ≥40 mm3
4 Detection of organ ischemia
EUR HEART J. 2014;35(41):2873-2926
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007
Recurrent Pleural
Effusion
Progressive Maximum Aortic Wall
Thickness (>10 mm)
005 006
Ulcer-like Projection in the
Involved Segment
EUR HEART J. 2014;35(41):2873-2926
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Uptake of 18F-FDG: The New Predictor For Type B IMH
Positron Emission Tomography/
Computed Tomography (PET/CT)
Experimental
Basis
18F-FDG uptake were
enriched in leukocytes
Acute inflammation reaction and
repair process result in
accumulation of hypermetabolic
cells such as macrophages
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PET/CTCTA PET
Imaging Evaluation
CTAInitial ULP
Maximum aortic diameter
PET/CT
Maximum standardized uptake value of aortic wall (SUVmax)
Maximum standardized uptake value of liver (SUVliver)
SUVratio (SUVmax divided by SUVliver )
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Definition of Adverse Aortic Event
(AAE)
Conversion to TEVAR (clinical and/or morphologic
deterioration)
Development of AD with intimal flap (classic or localized)
Enlargement of initial ULP
Newly developed ULP
Aortic enlargement (≥50mm or increased by 25%)
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Patient Characteristics (Mar.2015 - Mar.2016)
Total (N=34) AAEs(n=18) NO AAEs (n=16) P
Age, y 57.97±9.18 57.56±10.07 58.44±8.37 0.986
Male/female 28/6 15/3 13/3 >0.999
Heart rate, bpm 75.91±10.6 76.72±11.74 75±9.45 0.670
Onset time, d 4.06±2.89 3.61±2.55 4.56±3.25 0.484
Smoke, n(%) 12(35.3) 7(38.9) 5(31.3) 0.729
Hypertension, n(%) 31(91.2) 18(100.0) 13(81.3) 0.094
Hyperlipidemia, n(%) 5(14.7) 4(22.2) 1(6.3) 0.340
Diabetes mellitus, n(%) 2(5.9) 1(5.6) 1(6.3) >0.999
Coronary artery disease,n(%) 4(11.8) 2(11.1) 2(12.5) >0.999
Renal insufficiency, n(%)* 4(11.8) 4(22.2) 0(0) 0.105
Pneumonia, n(%) 2(5.9) 1(5.6) 1(6.3) >0.999
Visceral ischemia, n(%) 2(5.9) 1(5.6) 1(6.3) >0.999
Pleural effusion, n(%) 6(17.6) 5(29.4) 1(6.3) 0.175
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Early Progression of IMH
Patients N=34
Follow-up period, day (M) 42 ( 33.63)
Composite endpoint (AAEs), n(%) 18 (52.9)
TEVAR, n(%) 3 (8.8)
Development to aortic dissection , n(%) 12 (35.3)
Enlargement of initial ULP, n(%) 14 (41.2)
New appearance of ULP, n(%) 7 (20.6)
Aortic dilation, n(%) 4 (11.8)
Values are presented as n (%) or median (25th-75th percentile).
IMH, intramural hematoma; TEVAR, thoracic endovascular repair; ULP, ulcer like projection.
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Values are presented as n (%), mean±SD or median(25th-75th percentile).
ULP, ulcer like projection; SUV, standardized uptake value.
MAD,maximum aortic diameter, mm
Laboratory, Morphologic and Metabolic findings
Total
(n=34)
AAEs
(n=18)
No AAEs
(n=16)
P
D2-dimer, μg/L 1460(650-3135) 1855(690-3105) 1110(540-3140) 0.630
CRP, mg/L 87.5(35-123.8) 86.3(53.8-128.5) 87.5(9.8-110.5) 0.377
MAD, mm 36.5±4.95 36.83±4.23 36.4±5.87 0.772
ULP, n(%) 25(73.5) 15(83.3) 10(62.5) 0.250
SUVmax 4.03±0.82 4.29±0.58 3.73±0.98 0.020
SUVratio 1.25±0.2 1.28±0.13 1.24±0.27 0.144
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Mean area under the curve (AUC) was
0.827±0.084.
The optimal SUVratio cutoff point was 1.226
Sensitivity of 73.3%, specificity of 90.0%
ROC Analysis
AAEs
(n=15)
No AAEs
(n=10)
P
SUVmax 4.33±0.63 3.32±0.53 0.001
SUVratio 1.29±0.14 1.12±0.11 0.005
Patients with Ulcer-like Projection
Ulcer-like Projection Subgroup Analyze
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A 55-y-old man with
greater uptake of 18F-FDG
in the aortic wall:
A, ULP were detected at
the middle descending
aorta in initial CTA;
B-C, accumulation of 18F-
FDG in the aortic wall in
PET/CT , the SUVmax and
SUVratio were 4.8 and
1.33, respectively;
D, ULP progressed to
classic dissection 1 mo
after onset.
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A 52-y-old man with low
uptake of 18F-FDG in the
aortic wall:
A, ULP were detected at
the proximal descending
aorta in initial CTA;
B-C, No obvious
accumulation of 18F-FDG
in the aortic wall on
PET/CT, the SUVmax and
SUVratio were 2.7 and
1.13, respectively;
D, ULP had no change 35
days after onset.
A
D
B
C
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Patients having ULP with
greater uptake of 18F-FDG
in the aortic wall were more
likely to develop into AAEs.
Endovascular treatment for
patients with ULP +SUV max↑?
18F-FDG PET/CT may
provide a new approach
for predicting risk in
patients with type B IMH.
More careful surveillance
with imaging is
recommended for high-
risk patients.
Take Home Message
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THANK YOU
Danke
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Uptake of 18F-FDG: New Predictor
for Type B IMH Progression
Jianfang Luo, MD FACC FESC
Director, Vascular Center
Guangdong Cardiovascular Institute
Guangdong General Hospital
Guangzhou, China