Detection and Characterization of Endoleaks Following Endovascular Treatment of Abdominal Aortic Aneurysms using Contrast Harmonic Imaging (CHI) with Quantitative Perfusion Analysis (TIC) Compared to CT Angiography (CTA)

Zusammenfassung

Ziel: Zu überprüfen, inwieweit Contrast Harmonic Imaging (CHI) die Detektion von Endoleaks nach Endostenting von Aortenaneurysmen (BAA) ermöglicht. Material und Methoden: 51 Patienten mit Verdacht auf Endoleaks nach Endostent von Aneurysmen wurden mit CTA und Gefäßultraschall untersucht. Die von 2 Radiologen in Konsensus befundete Zweiphasen-CTA mit der in 8 Fällen durchgeführten selektiven Angiografie (DSA) dienten als Standardreferenz. Die Ultraschalluntersuchungen wurden von einem erfahrenen Untersucher mit einer Multifrequenz-Sonde (2 – 4 MHz) mit CHI nach Bolusinjektion von 2,4 ml SonoVue® (Maximum 5 ml) durchgeführt. Die Auswertung der Reperfusion des BAA mit der Time-Intensity-Curve(TIC)-Analyse erfolgte von 2 Auswertern im Konsensus. Ergebnisse: In 30 / 51 Fällen wurden Endoleaks durch CHI in Übereinstimmung mit der CTA nachgewiesen. In 20 Fällen fand sich kein Endoleak, korrelierend mit CTA/DSA. In einem Fall wurde ein kombiniertes Typ-I/II-Endoleak, gesichert durch DSA, mit CHI falsch als Typ-II-Leak charakterisiert. In einem Fall konnte primär ein Typ-II-Endoleak nur durch CHI, erst im Verlauf durch CTA nachgewiesen werden (Sens. 99 %, Spez. 93 %, NPV 99 %, PPV 95 %). Die TIC-Analyse ermöglichte in allen untersuchten Fällen eine Beurteilung der Perfusionsdynamik der Endoleaks. Dabei fanden sich signifikante Unterschiede (p < 0,05, Mann-Whitney-U-Test) der Perfusionswerte im Aneurysmasack bei lokaler Perfusion durch ein Endoleak (10,39 ± 4,29 dB) oder bei fehlendem Endoleak (6,42 ± 2,86 dB). Schlussfolgerung: Mit CHI mit Perfusionsanalyse gelingt eine sichere Detektion von Endoleaks. Nicht nur bei Kontraindikationen für die CTA bietet CHI eine Alternative für ein postinterventionelles Monitoring.

Abstract

Purpose: To show the feasibility of the detection of endoleaks following endovascular treatment of aortic aneurysms using contrast harmonic imaging (CHI) in comparison to computed tomography angiography (CTA). Materials and Methods: 51 patients with suspected endoleaks, who underwent previous endovascular treatment for abdominal aortic aneurysm, were examined using CTA and vascular ultrasound. Biphasic CTA in all cases and digital subtraction angiography (DSA) in 8 patients were evaluated by two radiologists in consensus and served as the standard of reference. Ultrasound was performed by an experienced examiner with a multi-frequency linear transducer (2 – 4 MHz) using CHI following bolus injection of 2.4 ml of SonoVue® IV (maximum 5 ml). All images were evaluated by two observers in consensus regarding the reperfusion of the abdominal aneurysm using time intensity curve (TIC) analysis. Results: In 30 of 51 patients, endoleaks were detected concordantly in CHI and CTA. In 20 of 51 patients, no endoleak was found in CHI and CTA/DSA. In one patient, a type II endoleak could initially only be detected in CHI and was later confirmed in follow-up examinations by CTA (sens. 99 %, spec. 93 %, NPV 99 %, PPV 95 %). TIC analysis allowed evaluation of the perfusion dynamics of endoleaks in all patients. Significant differences were found (p < 0.05, Mann Whitney U Test) regarding the perfusion within the aneurysm when an endoleak was present (10.39 ± 4.29 dB) or not present (6.42 ± 2.86 dB). Conclusion: CHI with perfusion analysis allows definite detection of endoleaks, especially if contraindications for CTA are present. CHI presents an alternative for follow-up monitoring.

Key words

aorta - ultrasound - aneurysm

References

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