Dynamic Volumetric CT Angiography for the Detection and Classification of Endoleaks: Application of Cine Imaging Using a 320-Row CT Scanner with 16-cm Detectors

• Published in: Journal of vascular and interventional radiology Vol. 25; no. 8; pp. 1172 - 1180.e1
• Main Authors: Koike, Yuya, MD, Ishida, Kazufumi, RT, Hase, Soichiro, MD, PhD, Kobayashi, Yasuyuki, MD, PhD, Nishimura, Jun-ichi, MD, PhD, Yamasaki, Motoshige, MD, PhD, Hosaka, Norifumi, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2014
• Subjects: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - diagnostic imaging; Aortic Aneurysm, Abdominal - surgery; Aortography - instrumentation; Aortography - methods; Blood Vessel Prosthesis Implantation - adverse effects; Cineangiography - instrumentation; Cone-Beam Computed Tomography - instrumentation; Endoleak - diagnostic imaging; Endoleak - etiology; Endovascular Procedures - adverse effects; Equipment Design; Feasibility Studies; Female; Humans; Male; Multidetector Computed Tomography - instrumentation; Observer Variation; Patient Positioning; Predictive Value of Tests; Radiation Dosage; Radiographic Image Interpretation, Computer-Assisted; Radiology; Reproducibility of Results; Time Factors; Tomography Scanners, X-Ray Computed; Treatment Outcome; aortic lumen; endoleak; AAA; EVAR; contrast-to-noise ratio; body mass index; CNR; En; AL; HU; abdominal aortic aneurysm; endovascular aneurysm repair; excluded aneurysm; Hounsfield units; EA; BMI
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2014.03.019

Abstract Purpose To assess the feasibility and diagnostic performance of dynamic volumetric computed tomography (CT) angiography with large-area detectors in the detection and classification of endoleaks after endovascular aneurysm repair (EVAR). Materials and Methods Low-dose dynamic volumetric CT angiography performed with the patient in Fowler position was used to scan the entire stent graft with a 16-cm-area detector during the first follow-up examination after EVAR. There were 39 consecutive patients (36 men and 3 women; mean age, 74 y ± 8.7) examined with approximately 14–20 intermittent scans (temporal resolution, 2 s; scan range, 160 mm). The effective radiation dose, image quality, interobserver and intraobserver agreement for endoleak detection, and time delay between peak enhancement of the aorta and endoleaks were evaluated. Results All examinations with the patient in Fowler position enabled the entire stent graft to be scanned and were rated as diagnostic. The mean effective radiation dose was 13.1 mSv. Endoleaks were detected in eight patients (type Ia, n = 1; type II, n = 6; type III, n = 1). Interobserver agreement (κ = 0.794) and intraobserver agreement (κ = 1.00) for detection of endoleaks were excellent. The mean time delay between peak enhancement of the aorta and the endoleaks was significantly less for type I/III endoleaks (2.0 s ± 0) compared with type II endoleaks (5.3 s ± 1.0; P < .001). Conclusions Low-dose dynamic volumetric CT angiography performed with the patient in Fowler position is feasible after EVAR. Dynamic information, including cine imaging, the timing of peak enhancement, and the Hounsfield units index, is useful in detecting and classifying endoleaks.