Jesse Habets MD, Presenter: Nothing to Disclose

Herman J.A. Zandvoort, Abstract Co-Author: Nothing to Disclose

Frans L. Moll MD, PhD, Abstract Co-Author: Nothing to Disclose

Lambertus W. Bartels PhD, Abstract Co-Author: Nothing to Disclose

Evert-Jan Vonken MD, PhD, Abstract Co-Author: Nothing to Disclose

Joost van Herwaarden MD, PhD, Abstract Co-Author: Research Consultant, Koninklijke Philips NV

Tim Leiner MD, PhD, Abstract Co-Author: Speakers Bureau, Koninklijke Philips NV Research Grant, Bayer AG Research Grant, Bracco Group

The purpose of this study was to examine the additional diagnostic value of Magnetic Resonance Imaging (MRI) after administration of a weak albumin-binding contrast agent in post-EVAR patients with aneurysm growth.

MR imaging was performed in all patients with AAA growth ≥5 mm after EVAR and no or uncertain endoleak on CTA in the period between April 2011 and August 2013. All MRI scans were performed on a 1.5-T clinical MRI scanner after administration of the weak albumin-binding contrast agent gadobenate dimeglumine. The presence of endoleaks was assessed by visually comparing pre-contrast and post-contrast T1-weighted fat-saturated images. Post-contrast images were acquired 5 and 15 minutes after contrast administration.

Endoleaks were observed in 25/29 patients (86%) on the post-contrast MRI images. Sixteen (55%) patients had a type II endoleak visualized by MRI and occult on delayed CT images. In 6/22 patients (27%, Figure 1), both MRI and delayed CT imaging revealed a type II endoleak. However, MRI had also complementary value in these 5/6 patients (83%) by visualizing more feeding lumbar arteries (n=3) (important for treatment purposes) and by improving the visualization of the extent of the endoleak (n=3). In one patient, MRI detected a type II endoleak originating from the inferior mesenteric artery (IMA) in addition to the type 2 endoleak from a lumbar artery also detected by CTA. Three (10%) patients had additional type III/IV endoleaks at the level of the aneurysm sac (n=1) and iliac legs (n=2).

In patients with enlarging aneurysms of unknown origin after EVAR, MRI with a weak albumin binding contrast agent has additional diagnostic value for both the detection and determination of the origin of the endoleak. This can have important (interventional) treatment implications.

Endoleak is a common complication in patients after endovascular treatment of an abdominal aortic aneurysm (EVAR). In patients with aneurysm growth, the detection of endoleaks can have important clinical implications. CT angiography including delayed phase imaging can fail to detect endoleaks in patients with aneurysm growth (endotension). MRI after administration of an albumin-binding contrast agent can detect additional endoleaks in these patients and can guide interventional treatment.

Habets, J, Zandvoort, H, Moll, F, Bartels, L, Vonken, E, van Herwaarden, J, Leiner, T, MRI with a Weak Albumin Binding Contrast Agent has Additional Value for the Detection of Endoleaks in Patients with Enlarging Aneurysm after Endovascular Repair.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14007188.html