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The Journal of Cardiovascular Surgery 2019 April;60(2):221-9

DOI: 10.23736/S0021-9509.17.09921-9


language: English

Magnetic resonance imaging of the intraluminal thrombus in abdominal aortic aneurysms: a quantitative and qualitative evaluation and correlation with growth rate

Carsten BEHR-ANDERSEN 1 , Lise GAMMELGAARD 2, Ernst T. FRÜND 3, Marie DAHL 1, Jes S. LINDHOLT 1, 3

1 Cardiovascular Research Center, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark; 2 Department of Radiology, Viborg Regional Hospital, Viborg, Denmark; 3 Elitary Research Center of Individualized Treatment of Arterial Diseases (CIMA), Cardiovascular Center of Excellence (CAVAC), Department of Heart, Lung and Vascular Surgery, University Hospital of Odense, Denmark

BACKGROUND: The role of the intraluminal thrombus (ILT) in abdominal aortic aneurysm (AAA) growth remains incompletely understood. MRI is superior to other methods in depicting the morphology of the ILT. This study brings preliminary, but novel information on the presence and morphological characteristics of the ILT and AAA growth rates in a screening cohort.
METHODS: Cohort study with 46 patients from the Viborg Vascular Trial. All underwent one non-contrast-enhanced magnetic resonance imaging (MRI) at the end of follow-up. ILT presence was noted and, if present, it was allocated to one of four morphological categories based on visual appearance and signal intensity on T2 weighted images.
RESULTS: The mean growth rate was 1.95 mm/year ±0.87 (SD). The observation time was 5.59±0.63 (SD) years. ILT was present in AAA size groups as follows: 30-34.9 mm 20.00%, 35-39.9 mm 88.89%, 40-44.9 mm 81.25%, 45-49.9 mm 100% and 50-54.9 mm 100%. Out of 46, 8 had no ILT at the time of MRI. The presence of any sort of ILT yielded a significantly increased unadjusted and an adjusted growth rate of 1.09 mm/year (95% CI: 0.48; 1.70) and 1.24 mm/year (95% CI: 0.64; 1.83), respectively. All four thrombus types were retrospectively associated with an increased recorded growth rate compared with “no thrombus”. Presence of a thin circumferential thrombus was retrospectively associated with the highest increase in growth rate, viz. 2.09 mm/year (95% CI: 1.23; 2.95).
CONCLUSIONS: We observed faster growth rate in those AAA that had developed an ILT. Even faster growth was observed amongst those AAA containing a thin ILT located along the inner circumference.

KEY WORDS: Aortic aneurysm, abdominal - Magnetic resonance imaging - Vascular diseases

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