Computed tomography angiography in abdominal aortic endoleaks: what is the optimal protocol?
John M Kirby1, Kartik S Jhaveri, John R Kachura
1Department of Medical Imaging, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON.
Summary
Delayed computed tomography angiography (CTA) phases are crucial for detecting endoleaks after aortic stent-graft placement, making noncontrast phases unnecessary. Optimizing CTA protocols requires using identical parameters for arterial and delayed phases.
Area of Science:
- Radiology
- Vascular Surgery
- Medical Imaging
Background:
- Endoleak detection is critical for successful abdominal aortic aneurysm (AAA) repair using endovascular stent-grafts.
- Computed tomography angiography (CTA) is a primary imaging modality for surveillance after endovascular repair.
Purpose of the Study:
- To determine the diagnostic value of noncontrast and delayed phases in CTA for endoleak detection.
- To optimize CTA protocols for improved endoleak identification.
Main Methods:
- Retrospective review of CTA scans from patients who underwent abdominal aortic endovascular stent-graft placement.
- Analysis of noncontrast, arterial, and delayed (2-minute postcontrast) CTA phases.
- Comparison of arterial phase alone versus combined arterial and delayed phases, and assessment of noncontrast phase utility.
Main Results:
- Endoleaks were detected in 38 CTA studies.
- Arterial phase identified endoleaks in 79% of cases.
- Delayed phase uniquely detected endoleaks in 21% of cases, highlighting its importance.
- Noncontrast phase provided no additional diagnostic information when combined with arterial and delayed phases.
Conclusions:
- Delayed-phase imaging is essential for comprehensive endoleak detection.
- The noncontrast phase can be omitted from CTA protocols for endoleak surveillance.
- Standardizing imaging parameters for both arterial and delayed phases is recommended for consistent results.
Related Concept Videos
01:28Imaging Studies for Cardiovascular System V: CT
Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
01:26Aneurysm III: Interprofessional Care
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
01:27Imaging Studies III: Computed Tomography
DefinitionComputed Tomography (CT) of the genitourinary (GU) tract is a non-invasive imaging modality that utilizes X-rays and computer processing to generate detailed cross-sectional images of the urinary system, encompassing the kidneys, ureters, bladder, and adjacent structures such as the adrenal glands.PurposeCT scans of the GU tract serve several diagnostic and therapeutic purposes, including:Diagnosis of Urinary Tract Diseases: Detects kidney stones, tumors, cysts, and congenital...