Evaluation of intramural hematoma: a novel use of ¹⁸F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging

Aortic intramural hematoma (IMH) is one of the typical entities of acute aortic syndrome and probably accounts for 5–25% of all cases. The ulcer-like projections (ULP), which are described as a focal, blood-filled pouch protruding into the hematoma of the aortic wall, are regarded as one of the high-risk imaging features of IMH and may cause initial medical treatment failure and death.

We present a case report of an acute type B IMH patient with impaired renal function and newly developed ULP in the acute phase. The ¹⁸F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (¹⁸F-FDG PET/MR) was performed to evaluate the condition of aortic hematoma. The ¹⁸F-FDG focal uptake along the aortic wall of the hematoma was normal compared to the background (SUV_max 2.17; SUV_SVC 1.6; TBR 1.35). We considered the IMH stable in such cases and opted for medical treatment and watchful observation. Six months after discharge, the patient’s recovery was satisfactory, and aortic remodeling was ideal.

The ¹⁸F-FDG PET/MR is a novel tool to evaluate the risk of IMH patients and thus provides information for therapy selection.