Predictive Value of Imaging Indicators for Disease Progression in Acute Stanford Type B Aortic Intramural Hematoma Without Ulcer-like Lesions.

PURPOSE: To investigate the clinical outcomes of acute Stanford type B intramural hematoma (TBIMH) without ulcer-like lesions following medical management and to identify predictors of disease progression. MATERIALS AND METHODS: A retrospective analysis was performed on patients with acute TBIMH without ulcer-like lesions who received medical management. Patients were categorized into progression and nonprogression groups based on 1-year follow-up computed tomography angiography (CTA). Disease progression was defined as aortic rupture, aortic dissection, aortic enlargement (≥5 mm), or hematoma thickening (≥3 mm), while nonprogression was defined as complete/partial resolution or retention of the hematoma. A multivariate analysis identified the predictors of disease progression, and Kaplan-Meier curves were used to compare survival outcomes. RESULTS: A total of 110 patients (mean age 55.9±10.5 y, 25 females) were included, with 21 patients (19.1%) showing disease progression. Multivariate analysis revealed that the maximum aortic diameter (MAD) (OR=7.6, P=0.003) and maximum CT value of the hematoma (CTmax) (OR=1.04, P=0.025) were independently associated with disease progression. The optimal cutoff values for MAD and CTmax were 40.0 mm (AUC: 0.69, sensitivity: 38.1%, specificity: 92.1%) and 71.9 HU (AUC: 0.68, sensitivity: 76.2%, specificity: 66.3%), respectively. When MAD and CTmax were combined, the AUC increased to 0.75 (sensitivity: 81.0%, specificity: 66.3%). CONCLUSION: A model based on MAD and CTmax effectively stratifies progression risk in TBIMH without ulcer-like lesions, facilitating early intervention in high-risk patients.