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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).

View larger version (140K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Transverse CT images in a 69-year-old man treated with endovascular aneurysm repair. (a) Unenhanced image. (b, c) Contrast-enhanced images obtained in arterial (b) and delayed (c) phases demonstrated a high-attenuation area beyond the graft but within the aneurysmal sac (*). This finding was absent on a. Readers assigned a score of 5 in all reading sessions; this finding was confirmed with the reference standard.

View larger version (153K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Transverse CT images in a 69-year-old man treated with endovascular aneurysm repair. (a) Unenhanced image. (b, c) Contrast-enhanced images obtained in arterial (b) and delayed (c) phases demonstrated a high-attenuation area beyond the graft but within the aneurysmal sac (*). This finding was absent on a. Readers assigned a score of 5 in all reading sessions; this finding was confirmed with the reference standard.

View larger version (160K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Transverse CT images in a 69-year-old man treated with endovascular aneurysm repair. (a) Unenhanced image. (b, c) Contrast-enhanced images obtained in arterial (b) and delayed (c) phases demonstrated a high-attenuation area beyond the graft but within the aneurysmal sac (*). This finding was absent on a. Readers assigned a score of 5 in all reading sessions; this finding was confirmed with the reference standard.

View larger version (87K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Transverse CT images in a 72-year-old woman treated with endovascular aneurysm repair. (a) Arterial phase image did not demonstrate any high attenuation area beyond the graft. (b) Endoleak was diagnosed only on the basis of findings on a delayed phase image (low-flow leak). Findings at reading sessions A and B were interpreted as negative for endoleak. An endoleak on the posterior side of the aneurysmal sac (arrows) was confirmed with the reference standard.

View larger version (91K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Transverse CT images in a 72-year-old woman treated with endovascular aneurysm repair. (a) Arterial phase image did not demonstrate any high attenuation area beyond the graft. (b) Endoleak was diagnosed only on the basis of findings on a delayed phase image (low-flow leak). Findings at reading sessions A and B were interpreted as negative for endoleak. An endoleak on the posterior side of the aneurysmal sac (arrows) was confirmed with the reference standard.

View larger version (96K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Transverse CT images obtained in a 75-year-old man treated with endovascular aneurysm repair. (a) Unenhanced CT image allowed exclusion of any endoleak, thereby helping identify a calcification within the thrombus (arrows). (b) Arterial and (c) delayed phase CT images showed a high-attenuation area was present outside the graft but within the aneurysmal sac; this was diagnosed as endoleak in reading sessions A and C (arrows). The absence of endoleak was confirmed with the reference standard.

View larger version (125K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Transverse CT images obtained in a 75-year-old man treated with endovascular aneurysm repair. (a) Unenhanced CT image allowed exclusion of any endoleak, thereby helping identify a calcification within the thrombus (arrows). (b) Arterial and (c) delayed phase CT images showed a high-attenuation area was present outside the graft but within the aneurysmal sac; this was diagnosed as endoleak in reading sessions A and C (arrows). The absence of endoleak was confirmed with the reference standard.

View larger version (151K): [in this window] [in a new window] [Download PPT slide]   Figure 3c: Transverse CT images obtained in a 75-year-old man treated with endovascular aneurysm repair. (a) Unenhanced CT image allowed exclusion of any endoleak, thereby helping identify a calcification within the thrombus (arrows). (b) Arterial and (c) delayed phase CT images showed a high-attenuation area was present outside the graft but within the aneurysmal sac; this was diagnosed as endoleak in reading sessions A and C (arrows). The absence of endoleak was confirmed with the reference standard.