Abstract
Objectives
To evaluate the feasibility of unenhanced motion-sensitized-driven equilibrium (MSDE)-prepared balanced turbo field echo (BTFE) sequences for detecting endoleaks after endovascular aneurysm repair (EVAR).
Methods
Forty-six patients treated with EVAR for aortic and/or iliac arterial aneurysms underwent contrast-enhanced CT and MSDE-prepared BTFE sequences with and without flow suppression. Two independent observers reviewed these sequences and their subtraction images and assigned confidence levels for detecting endoleaks. Relative contrast values were calculated by dividing signal intensities by those of paraspinal muscles. CT provided the reference standard.
Results
CT showed types I and II endoleaks in one and ten patients, respectively. Areas under receiver operating characteristic curves were 0.92 and 0.97 for observers 1 and 2, respectively. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of both observers were 91 (10/11), 91(32/35), 91 (42/46), 77 (10/13) and 97 % (32/33), respectively. Relative contrast values of endoleaks and flowing blood significantly decreased by flow suppression on MSDE-prepared BTFE images (P = 0.002 and P < 0.0001 respectively), and were significantly higher than those of the excluded aneurysms on subtraction images (P = 0.003 and P = 0.001, respectively).
Conclusions
Unenhanced MSDE-prepared BTFE sequences are feasible for detecting endoleaks.
Key points
• Flow suppression significantly reduces endoleak signals on MSDE-prepared BTFE images.
• Subtraction images of MSDE-prepared BTFE sequences ± flow suppression demonstrate endoleaks.
• MSDE-prepared BTFE sequences indicate high diagnostic values (>90 %) except PPV (77 %).
• MSDE-prepared BTFE sequences need further refinement to reduce false positives.
• Endoleaks can be detected without contrast injection using MSDE-prepared BTFE sequences.
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Acknowledgments
The scientific guarantor of this publication is Kensaku Mori. The authors of this manuscript declare relationships with the following companies: Philips Medical Systems provided the authors with the motion-sensitized driven equilibrium preparation pulse before selling on the market as a clinical science key. This study has received funding by Grant in Aid for Scientific Research (C) from Japan Society for Promotion of Science (JSPS KAKENHI); Contract grant number: 24591864. No complex statistical methods were necessary for this paper. The Ethics Committee for Clinical Research, University of Tsukuba Hospital approved this study. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, diagnostic or prognostic study, performed at one institution. The authors thank Masashi Shindo RT, Taketo Toki RT, Koji Yamada RT, and Takao Ishimori RT for their technical support.
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Mori, K., Saida, T., Sato, F. et al. Endoleak detection after endovascular aneurysm repair using unenhanced MRI with flow suppression technique: Feasibility study in comparison with contrast-enhanced CT. Eur Radiol 27, 336–344 (2017). https://doi.org/10.1007/s00330-016-4315-5
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DOI: https://doi.org/10.1007/s00330-016-4315-5