Kensaku Mori MD, Presenter: Nothing to Disclose

Tsukasa Saida MD, Abstract Co-Author: Nothing to Disclose

Fujio Sato, Abstract Co-Author: Nothing to Disclose

Katsuhiro Nasu MD, PhD, Abstract Co-Author: Nothing to Disclose

Toshitaka Ishiguro MD, Abstract Co-Author: Nothing to Disclose

Takahiro Konishi MD, Abstract Co-Author: Nothing to Disclose

Yoko Uchikawa MD, Abstract Co-Author: Nothing to Disclose

Sodai Hoshiai MD, Abstract Co-Author: Nothing to Disclose

Takashi Hiyama MD, Abstract Co-Author: Nothing to Disclose

Manabu Minami MD, PhD, Abstract Co-Author: Nothing to Disclose

To evaluate the diagnostic accuracy of unenhanced balanced turbo field echo sequence (BTFE) with motion-sensitized driven equilibrium (MSDE) for detecting endoleaks after endovascular aortic repair (EVAR).

We included 26 patients (20 men and 6 women; mean age, 72.5 years; age range, 47-85 years) who had undergone EVAR for aortic and/or iliac arterial aneurysms. All patients underwent contrast-enhanced CT and unenhanced MR imaging including ordinary BTFE, BTFE with MSDE using no velocity encoding (VENC) (bright blood imaging), and BTFE with MSDE using VENC of 5 cm/s (black blood imaging). The interval between the contrast-enhanced CT and unenhanced MR imaging ranged from 0 to 6 days (mean, 0.6 days). Two independent observers, unaware of the contrast-enhanced CT results, reviewed the unenhanced MR images and the subtraction images reconstructed from the bright and black blood imaging. The confidence levels for the presence of endoleaks were assigned on a 5-point scale. The diagnositc accuracy was assessed by the receiver operating characteristic (ROC) analysis. The contrast-enhanced CT results served as the reference standard. The interobserver agreement was evaluated by the kappa statistics. Additionally, the artifact levels on subtraction images were assigned as no, minimal, moderate, or severe.

On contrast-enhanced CT, 1 and 5 patients had type-1 and type-2 endoleaks, respectively. The respective area under the ROC curve, accuracy, sensitivity, and specificity for detecting endoleaks on unenhanced MR imaging were 0.983, 92.3%, 100%, and 90% for the observer 1 and 0.992, 96.2%, 100%, and 95% for the observer 2. The kappa value was 0.651, indicating good interobserver agreement. No, minimal, moderate, and severe artifact was assigned in 19, 4, 3, and 0 patients by the observer 1 and in 13, 9, 4, and 0 patients by the observer 2, respectively.

Endoleaks can be accurately diagnosed on BTFE with MSDE without use of contrast medium.

BTFE with MSDE is a truly non-invasive method to detect endoleaks after EVAR, requring neither contrast-medium injection nor radiation exposure. Thus, this technique will help to reduce invasiveness of follow-up imaging after EVAR, especially in patients with renal dysfunction.

Mori, K, Saida, T, Sato, F, Nasu, K, Ishiguro, T, Konishi, T, Uchikawa, Y, Hoshiai, S, Hiyama, T, Minami, M, Detection of Endoleaks after Endovascular Aortic Repair Using Unenhanced MR Imaging: Diagnostic Accuracy of Balanced Turbo Field Echo Sequence with Motion-sensitized Driven Equilibrium.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004716.html