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Feasibility of shear wave sonoelastography to detect endoleak and evaluate thrombus organization after endovascular repair of abdominal aortic aneurysm

  • Vascular-Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the feasibility of shear wave sonoelastography (SWS) for endoleak detection and thrombus characterization of abdominal aortic aneurysm (AAA) after endovascular repair (EVAR).

Materials and methods

Participants who underwent EVAR were prospectively recruited between November 2014 and March 2016 and followed until March 2019. Elasticity maps of AAA were computed using SWS and compared to computed tomography angiography (CTA) and color Doppler ultrasound (CDUS). Two readers, blinded to the CTA and CDUS results, reviewed elasticity maps and B-mode images to detect endoleaks. Three or more CTAs per participant were analyzed: pre-EVAR, baseline post-EVAR, and follow-ups. The primary endpoint was endoleak detection. Secondary endpoints included correlation between total thrombus elasticity, proportion of fresh thrombus, and aneurysm growth between baseline and reference CTAs. A 3-year follow-up was made to detect missed endoleaks, EVAR complication, and mortality. Data analyses included Cohen’s kappa; sensitivity, specificity, and positive predictive value (PPV); Pearson coefficient; and Student’s t tests.

Results

Seven endoleaks in 28 participants were detected by the two SWS readers (k = 0.858). Sensitivity of endoleak detection with SWS was 100%; specificity and PPV averaged 67% and 50%, respectively. CDUS sensitivity was estimated at 43%. Aneurysm growth was significantly greater in the endoleak group compared to sealed AAAs. No correlation between growth and thrombus elasticity or proportion of fresh thrombus in AAAs was found. No new endoleaks were observed in participants with SWS negative studies.

Conclusion

SWS has the potential to detect endoleaks in AAA after EVAR with comparable sensitivity to CTA and superior sensitivity to CDUS.

Key Points

• Dynamic elastography with shear wave sonoelastography (SWS) detected 100% of endoleaks in abdominal aortic aneurysm (AAA) follow-up that were identified by a combination of CT angiography (CTA) and color Doppler ultrasound (CDUS).

• Based on elasticity maps, SWS differentiated endoleaks from thrombi within the aneurysm sac (p < 0.001).

• After 3-year follow-up, no new endoleaks were observed in SWS negative examinations.

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Abbreviations

AAA:

Abdominal aortic aneurysm

CDUS:

Color Doppler ultrasound

CEUS:

Contrast-enhanced ultrasound

CT:

Computed tomography

CTA:

Computed tomography angiography

EVAR:

Endovascular aortic aneurysm repair

kPa:

Kilopascal

MRI:

Magnetic resonance imaging

PPV:

Positive predictive value

ROI:

Region of interest

SWS:

Shear wave sonoelastography

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Acknowledgments

We are grateful to Jennifer Satterthwhaite, RN, for organizing the logistics of this project. We thank Michel Gouin, RT, for his work on US data acquisitions. Finally, we express our gratitude to Line Julien for recruiting participants. A preliminary version of this work has been presented as an abstract at RSNA 2017, Chicago, IL, USA. Paper Number: SSJ25-06.

Funding

This study received funding from Fonds de Recherche du Québec – Santé (FRQS) (ARQ #22951) and the Canadian Institutes of Health Research (MOP #115099). AT is supported by a Junior 2 Research Award from the FRQS and by the Fondation de l’Association des Radiologistes du Québec (#34939).

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Author notes

  1. Nicolas Voizard and Antony Bertrand-Grenier contributed equally to this work.

Authors and Affiliations

  1. Laboratory of Clinical Imaging Processing, Centre hospitalier de l’Université de Montréal (CHUM) Research Center (CRCHUM), Montréal, Québec, Canada

    Nicolas Voizard, Antony Bertrand-Grenier, Husain Alturkistani, Eric Therasse, An Tang, Claude Kauffmann & Gilles Soulez

  2. Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada

    Nicolas Voizard, Antony Bertrand-Grenier, Husain Alturkistani, Eric Therasse, An Tang, Claude Kauffmann & Gilles Soulez

  3. Department of Physics, Université de Montréal, Montréal, Canada

    Antony Bertrand-Grenier

  4. Department of Radiology, Centre hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada

    Eric Therasse, An Tang, Guy Cloutier & Gilles Soulez

  5. Institute of Biomedical Engineering, Université de Montréal, Montréal, Québec, Canada

    An Tang, Guy Cloutier & Gilles Soulez

  6. Laboratory of Biorrheology and Medical Ultrasound, CRCHUM, Montréal, Québec, Canada

    Guy Cloutier

  7. Centre de Recherche, Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 rue St Denis, Montréal, QC, H2X 0A9, Canada

    Gilles Soulez

Authors
  1. Nicolas Voizard
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Corresponding author

Correspondence to Gilles Soulez.

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Guarantor

The scientific guarantor of this publication is Gilles Soulez, MD, MSc.

Conflict of interest

The authors declare that they have no competing interests.

Statistics and biometry

Paule Bodson-Clermont kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

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Institutional Review Board approval was obtained.

Methodology

• prospectively performed at one institution

Additional information

A preliminary version of this work has been presented as an abstract at RSNA 2017, Chicago, IL, USA. Paper Number: SSJ25-06.

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Voizard, N., Bertrand-Grenier, A., Alturkistani, H. et al. Feasibility of shear wave sonoelastography to detect endoleak and evaluate thrombus organization after endovascular repair of abdominal aortic aneurysm. Eur Radiol 30, 3879–3889 (2020). https://doi.org/10.1007/s00330-020-06739-3

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  • DOI: https://doi.org/10.1007/s00330-020-06739-3

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