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Dual-source dual-energy CT: dose reduction after endovascular abdominal aortic aneurysm repair

  • Computed Tomography
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Abstract

Purpose

This study was done to evaluate the possibility of reducing the dose of ionising radiation by using dual-source dual-energy computed tomography (CT) in patients undergoing CT angiography of the aorta to search for endoleaks after endovascular aneurysm repair (EVAR).

Materials and methods

One hundred and forty-eight patients (117 M, 31 F; mean age 75 ± 6.5) underwent 171 CT angiography scans for follow-up after EVAR. For each patient we performed a triple-phase acquisition protocol consisting of a nonenhanced phase, an arterial phase and a delayed phase; the latter acquired in dual energy. Two radiologists jointly evaluated the nonenhanced, arterial and delayed phase, and a third radiologist evaluated only the delayed phase and its virtual noncontrast (VNC) reconstruction. Moreover, we compared the cumulative effective doses of the triple-phase acquisition with the dual-energy acquisition.

Results

We detected 34 endoleaks (19.8 %), with 100 % agreement between the triple-phase and dual-energy acquisitions. The effective dose of dual-energy acquisition performed during the delayed phase was 61.7 % lower than that of the triple-phase acquisition.

Conclusions

A dual-energy CT scan acquired during the delayed phase and its VNC reconstruction allow detection of endoleaks with a substantial reduction of effective dose and a complete diagnostic agreement with a triple-phase acquisition protocol.

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References

  1. Fleming C, Whitlock EP, Beil TL et al (2005) Screening for abdominal aortic aneurysm: a best-evidence systematic review for the preventive services task force. Ann Intern Med 142:203–211

    Article  PubMed  Google Scholar 

  2. Sterpetti AV, Cavallaro A, Cavallari N et al (1991) Factors influencing the rupture of abdominal aortic aneurysms. Surg Gynecol Obstet 173(3):175–178

    CAS  PubMed  Google Scholar 

  3. Hatakeyama T, Shigematsu H, Muto T (2001) Risk factors for rupture of abdominal aortic aneurysm based on three-dimensional study. J Vasc Surg 33:453–461

    Article  CAS  PubMed  Google Scholar 

  4. Eefting D, Ultee KH, Von Meijenfeldt GC et al (2013) Ruptured AAA: state of the art management. J Cardiovasc Surg 54(Suppl 1):47–53

    CAS  Google Scholar 

  5. Karkos CD, Sutton AJ, Bown MJ et al (2011) A meta-analysis and metaregression analysis of factors influencing mortality after endovascular repair of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 42:775–786

    Article  CAS  PubMed  Google Scholar 

  6. Görich J, Rilinger N, Sokiranski R et al (1999) Leakages after endovascular repair of aortic aneurysms: classification based on findings at CT, angiography and radiography. Radiology 213:767–772

    Article  PubMed  Google Scholar 

  7. Iezzi R, Cotroneo AR, Filippone A et al (2006) Multidetector-row CT in abdominal aortic aneurysm treated with endovascular repair: are unenhanced and delayed phase enhanced images really effective for endoleak detection? Radiology 241:915–921

    Article  PubMed  Google Scholar 

  8. Iezzi R, Cotroneo AR, Marano R et al (2008) Endovascular treatment of thoracic aortic diseases: follow-up and complications with multidetector computed tomography angiography. Eur J Radiol 65:365–376

    Article  PubMed  Google Scholar 

  9. Stavropoulos SW, Charagundla SR (2007) Imaging techniques for detection and management of endoleaks after endovascular aortic aneurysm repair. Radiology 243:641–655

    Article  PubMed  Google Scholar 

  10. Mancuso M, Pasquali E, Leonardi S et al (2008) Oncogenic bystander radiation effects in patched heterozygous mouse cerebellum. Proc Natl Acad Sci USA 105:12445–12450

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  11. Clevert DA, Minaifar N, Kopp R et al (2009) Imaging of endoleaks after endovascular aneurysm repair (EVAR) with contrast-enhanced ultrasound (CEUS). A pictorial comparison with CTA. Clin Hemorheol Microcirc 41:151–168

    PubMed  Google Scholar 

  12. Macari M, Chandarana H, Schmidt B et al (2006) Abdominal aortic aneurysm: can the arterial phase at CT evaluation after endovascular repair be eliminated to reduce radiation dose? Radiology 241:908–914

    Article  PubMed  Google Scholar 

  13. Chandarana H, Godoy MC, Vlahos I et al (2008) Abdominal aorta: evaluation with dual-source dual-energy multidetector CT after endovascular repair of aneurysms–initial observations. Radiology 249:692–700

    Article  PubMed  Google Scholar 

  14. Johnson TR, Krauss B, Sedlmair M et al (2007) Material differentiation by dual energy CT: initial experience. Eur Radiol 17:1510–1517

    Article  PubMed  Google Scholar 

  15. Fayngersh V, Passero M (2009) Estimating radiation risk from computed tomography scanning. Lung 187:143–148

    Article  PubMed  Google Scholar 

  16. Motta R, Rubaltelli L, Vezzaro R et al (2012) Role of multidetector CT angiography and contrast-enhanced ultrasound in redefining follow-up protocols after endovascular abdominal aortic aneurysm repair. Radiol Med 117:1079–1092

    Article  CAS  PubMed  Google Scholar 

  17. Carrafiello G, Recaldini C, Laganà D et al (2008) Endoleak detection and classification after endovascular aneurysm treatment of abdominal aortic aneurysm: value of CEUS over CTA. Abdom Imaging 33:357–362

    Article  PubMed  Google Scholar 

  18. Nyheim T, Staxrud LE, Rosen L et al (2013) Review of postoperative CT and ultrasound for endovascular aneurysm repair using Talent stent graft: can we simplify the surveillance protocol and reduce the number of CT scans? Acta Radiol 54:54–58

    Article  PubMed  Google Scholar 

  19. Collins JT, Boros MJ, Combs K (2007) Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography. Ann Vasc Surg 21:671–675

    Article  PubMed  Google Scholar 

  20. Clevert DA, Minaifar N, Weckbach S et al (2008) Color duplex ultrasound and contrast-enhanced ultrasound in comparison to MS-TC in the detection of endoleak following endovascular aneurysm repair. Clin Hemoreol Microcirc 39:121–132

    Google Scholar 

  21. Giannoni MF, Fanelli F, Citrone M et al (2007) Contrast ultrasound imaging: the best method to detect type II endoleak during endovascular aneurysm repair follow-up. Interact Cardiovasc Thoracic Surg 6:259–262

    Article  Google Scholar 

  22. Napoli V, Bargellini I, Sardella SG et al (2004) Abdominal aortic aneurysm: contrast-enhanced US for missed endoleaks after endoluminal repair. Radiology 233:217–225

    Article  PubMed  Google Scholar 

  23. van der Laan MJ, Bartels LW, Viergever MA et al (2006) Computed tomography versus magnetic resonance imaging of endoleaks after EVAR. Eur J Vasc Endovasc Surg 32:361–365

    Article  PubMed  Google Scholar 

  24. Pitton MB, Schweitzer H, HHerber S et al (2005) MRI versus helical CT for endoleak detection after endovascular aneurysm repair. AJR Am J Roentgenol 185:1275–1281

    Article  PubMed  Google Scholar 

  25. Scaglione M, Pinto A, Pinto F et al (2001) Role of contrast-enhanced helical CT in the evaluation of acute thoracic aortic injuries after blunt chest trauma. Eur Radiol 11:2444–2448

    Article  CAS  PubMed  Google Scholar 

  26. Görich J, Rilinger N, Söldner J et al (1999) Endovascular repair of aortic aneurysm: treatment of complications. J Endovasc Surg 6:136–146

    Article  PubMed  Google Scholar 

  27. Wolf YG, Tillich M, Lee WA et al (2002) Changes in aneurysm volume after endovascular repair of abdominal aortic aneurysm. J Vasc Surg 36:305–309

    Article  PubMed  Google Scholar 

  28. El Batti S, Cochennec F, Roudot-Thoraval F (2013) Type II endoleaks after endovascular repair of abdominal aortic aneurysm are not always a benign condition. J Vasc Surg 25:S0741–S5214

    Google Scholar 

  29. Patatas K, Ling L, Dunning J et al (2012) Static sac size with a type II endoleak post-endovascular abdominal aortic aneurysm repair: surveillance or embolization? Interact Cardiovasc Thorac Surg 15:462–466

    Article  PubMed Central  PubMed  Google Scholar 

  30. Saba L, Montisci R, Sanfilippo R et al (2009) Imaging of the endoleak after endovascular aneurysm repair procedure by using multidetector computer tomography angiography. J Cardiovasc Surg 50:515–526

    CAS  Google Scholar 

  31. Ron E (2003) Cancer risks from medical radiation. Health Phys 85:47–59

    Article  CAS  PubMed  Google Scholar 

  32. Berrington de Gonzalez A, Darby S (2004) Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 363:345–351

    Article  PubMed  Google Scholar 

  33. Brenner DJ, Hall EJ (2007) Computed tomography: an increasing source of radiation exposure. N Engl J Med 357:2277–2284

    Article  CAS  PubMed  Google Scholar 

  34. Sommer WH, Graser A, Becker CR et al (2010) Image quality of virtual non-contrast images derived from dual energy CT angiography after endovascular aneurysm repair. J Vasc Interv Radiol 21:315–321

    Article  PubMed  Google Scholar 

  35. Stolzmann P, Frauenfelder T, Pfammatter T et al (2008) Endoleaks after endovascular abdominal aortic aneurysm repair: detection with dual-energy dual-source CT. Radiology 249:682–691

    Article  PubMed  Google Scholar 

  36. Brägelmann A, Bunck A, Donas K et al (2013) Dual-energy CT in the follow-up after endovascular abdominal aortic aneurysm repair. Rofo 185:351–357

    Article  PubMed  Google Scholar 

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Conflict of interest

Vitaliano Buffa, Antonio Solazzo, Valeria D’Auria, Alessandra Del Prete, Andrea Vallone, Monica Luzietti, Manuela Madau, Roberto Grassi, Vittorio Miele declare no conflict of interest.

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Authors and Affiliations

  1. UOC Radiologia Cardiovascolare e d’Urgenza, AO San Camillo Forlanini, Rome, Italy

    Vitaliano Buffa, Andrea Vallone, Monica Luzietti, Manuela Madau & Vittorio Miele

  2. Sezione di Radiologia, Dipartimento Magrassi-Lanzara, Seconda Università di Napoli, Naples, Italy

    Antonio Solazzo, Valeria D’Auria, Alessandra Del Prete & Roberto Grassi

Authors
  1. Vitaliano Buffa
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  2. Antonio Solazzo
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  3. Valeria D’Auria
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  4. Alessandra Del Prete
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  6. Monica Luzietti
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  8. Roberto Grassi
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  9. Vittorio Miele
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Correspondence to Vitaliano Buffa.

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Buffa, V., Solazzo, A., D’Auria, V. et al. Dual-source dual-energy CT: dose reduction after endovascular abdominal aortic aneurysm repair. Radiol med 119, 934–941 (2014). https://doi.org/10.1007/s11547-014-0420-1

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  • DOI: https://doi.org/10.1007/s11547-014-0420-1

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