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Dual-energy computed tomography after endovascular aortic aneurysm repair: The role of hard plaque imaging for endoleak detection

  • Computed Tomography
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Abstract

Objectives

To assess the diagnostic accuracy of dual-energy computed tomography (DECT) for detection of endoleaks and aneurysm sac calcifications after endovascular aneurysm repair (EVAR) using hard plaque imaging algorithms.

Materials and methods

One hundred five patients received 108 triple-phase contrast-enhanced CT (non-contrast, arterial and delayed phase) after EVAR. The delayed phase was acquired in dual-energy and post-processed using the standard (HPI-S) and a modified (HPI-M) hard plaque imaging algorithm. The reference standard was determined using the triple-phase CT and contrast-enhanced ultrasound. All images were analysed separately for the presence of endoleaks and calcifications by two independent readers; sensitivity, specificity and interobserver agreement were calculated.

Results

Endoleaks and calcifications were present in 25.9 % (28/108) and 20.4 % (22/108) of images. The HPI-S images had a sensitivity/specificity of 54 %/100 % (reader 1) and 57 %/99 % (reader 2), the HPI-M images of 93 %/92 % (reader 1) and 96 %/92 % (reader 2) for detection of endoleaks. For detection of calcifications HPI-S had a sensitivity/specificity of 91 %/99 % (reader 1) and 95 %/97 % (reader 2), the HPI-M images of 91 %/99 % (reader 1) and 91 %/99 % (reader 2), respectively.

Conclusion

Using HPI-M, DECT enables an accurate diagnosis of endoleaks after EVAR and allows distinguishing between endoleaks and calcifications with high diagnostic accuracy.

Key Points

• Dual-energy computed tomography allows the diagnosis of aortic pathologies after EVAR.

• Hard plaque imaging algorithms can distinguish between endoleaks and aneurysm sac calcifications.

• The modified hard plaque imaging algorithm detects endoleaks with high diagnostic accuracy.

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Abbreviations

CEUS:

Contrast-enhanced ultrasound

DECT:

Dual-energy computed tomography

EVAR:

Endovascular aneurysm repair

HPI (S/M):

Hard plaque imaging (standard/modified)

MMWP:

Multimodality workplace

VNC:

Virtual non-contrast

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Acknowledgments

The scientific guarantor of this publication is C. Dornia. The authors of this manuscript declare relationships with the following companies: B. Krauss is an employee of Siemens AG, Healthcare Sector, Germany. The remaining authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. F. Zeman kindly provided statistical advice for this manuscript. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany

    R. Müller-Wille, T. Borgmann, W. A. Wohlgemuth, E. M. Jung, P. Heiss, A. G. Schreyer, C. Stroszczynski & C. Dornia

  2. Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany

    F. Zeman

  3. Department of Surgery, University Medical Center Regensburg, Regensburg, Germany

    K. Pfister

  4. Siemens AG, Healthcare Sector, Forchheim, Germany

    B. Krauss

Authors
  1. R. Müller-Wille
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  2. T. Borgmann
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  3. W. A. Wohlgemuth
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  4. F. Zeman
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  5. K. Pfister
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  6. E. M. Jung
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  7. P. Heiss
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  8. A. G. Schreyer
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  9. B. Krauss
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  10. C. Stroszczynski
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  11. C. Dornia
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Corresponding author

Correspondence to R. Müller-Wille.

Additional information

R. Müller-Wille and T. Borgmann both contributed equally.

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Müller-Wille, R., Borgmann, T., Wohlgemuth, W.A. et al. Dual-energy computed tomography after endovascular aortic aneurysm repair: The role of hard plaque imaging for endoleak detection. Eur Radiol 24, 2449–2457 (2014). https://doi.org/10.1007/s00330-014-3266-y

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  • DOI: https://doi.org/10.1007/s00330-014-3266-y

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