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Multidetector CT in Abdominal Aortic Aneurysm Treated with Endovascular Repair: Are Unenhanced and Delayed Phase Enhanced Images Effective for Endoleak Detection?¹

¹ From the Department of Clinical Science and Bioimaging, Section of Radiology, G. D'Annunzio University, SS Annunziata Hospital, Via dei Vestini, 66013 Chieti, Italy (R.I., A.R.C., A.F., F.D.F., F.Q., C.C.); and Department of Bioimaging and Radiological Science, Institute of Radiology, Catholic University, Rome, Italy (L.B.). Received June 8, 2005; revision requested August 2; revision received October 13; accepted November 14; final version accepted February 2, 2006. Address correspondence to R.I. (e-mail: r.iezzi{at}rad.unich.it).

Purpose: To retrospectively determine the sensitivity and specificity of unenhanced, delayed enhanced phase (DEP), and arterial enhanced phase (AEP) multi–detector row computed tomography (CT) for depicting endoleaks during follow-up of endovascular aneurysm repair.

Materials and Methods: Fifty patients (two women, 48 men; mean age, 72 years) underwent follow-up multi–detector row CT 1, 6, and 12 months after endovascular aneurysm repair. Unenhanced CT was performed with 2.5-mm collimation; 1-mm collimation was used with AEP and DEP examinations. Two independent readers assessed the presence of endoleak in three reading sessions: AEP (session A), unenhanced and AEP (session B), and AEP and DEP (session C). At 6- and 12-month follow-up, a fourth set was included: 1-month unenhanced and AEP (session D). Sensitivity, specificity, and positive predictive value of each session were calculated. Triple-phase multi–detector row CT was the reference standard.

Results: At 1 month, sensitivity, specificity, and positive predictive value, respectively, were 79%, 75%, and 55% for session A; 93%, 97%, and 93% for session B; and 93%, 78%, and 62% for session C. At 6 months, sensitivity, specificity, and positive predictive value, respectively, were 92%, 68%, and 48% for session A; 92%, 100%, and 100% for session B; and 100%, 84%, and 67% for session C. At 12 months, sensitivity, specificity, and positive predictive value, respectively, were 80%, 80%, and 50% for session A; 90%, 98%, and 90% for session B; and 100%, 80%, and 56% for session C. Sensitivity did not significantly differ (P > .05) among reading sessions A, B, and C, whereas specificity and positive predictive values in session B were significantly higher (P < .001). For 6- and 12-month follow-up, no significant differences (P > .05) were found between sessions D and B.

Conclusion: The combination of AEP and unenhanced imaging performed at 1-month follow-up offers improved specificity and positive predictive values compared with AEP alone. DEP imaging does not significantly increase sensitivity for detection of endoleaks, but it does depict low-flow endoleaks not seen at AEP.

© RSNA, 2006

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