Georg Apfaltrer1,2, Francesco Lavra1,3, U Joseph Schoepf1,4, Marco Scarabello1,5, Ricardo Yamada6, Marly van Assen1,7, Akos Varga-Szemes1, Brian E Jacobs1, Maximilian J Bauer1, William T Greenberg1, Marcelo Guimaraes6, Luca Saba3, Carlo N De Cecco1. 1. Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America. 2. Division of Pediatric Radiology, Department of Radiology, Medical University of Graz, Graz, Austria. 3. Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy. 4. Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, United States of America. 5. Postgraduate School in Radiodiagnostics, Universita degli Studi di Milano, Milan, Italy. 6. Division of Vascular Interventional Radiology, Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, United States of America. 7. Center for Medical Imaging, University Medical Center Groningen, North East Netherlands, Groningen, The Netherlands.
Abstract
OBJECTIVES: To assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR). MATERIAL AND METHODS: Twenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers. RESULTS: In total, 19 patients (18 males, median age 74 years [70.5-75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5-5] vs. 4.5 [4-5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1-1] vs 1.5 [1.5-1.5], respectively; p <0.01). Moreover, the dCTP endoleak index was significantly higher than the dCTA index (18.5 [10.8-20.5] vs. 3.5 [5-2.7], respectively; p = 0.02). CONCLUSIONS: Quantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.
OBJECTIVES: To assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR). MATERIAL AND METHODS: Twenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers. RESULTS: In total, 19 patients (18 males, median age 74 years [70.5-75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5-5] vs. 4.5 [4-5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1-1] vs 1.5 [1.5-1.5], respectively; p <0.01). Moreover, the dCTP endoleak index was significantly higher than the dCTA index (18.5 [10.8-20.5] vs. 3.5 [5-2.7], respectively; p = 0.02). CONCLUSIONS: Quantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.
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