Visualizing type IV endoleak using magnetic resonance imaging with a blood pool contrast agent

Growing evidence suggests that graft porosity hampers aneurysm shrinkage in patients who have been treated with the original Excluder device. To our knowledge, this suspected porosity has never been visualized in such patients. We present three patients treated with the original Excluder device whose aneurysms did not shrink in the first 2 years after treatment. Computed tomography (CT) angiography and late phase CT did not show endoleak. We performed late phase magnetic resonance imaging with a blood pool agent to visualize graft porosity. Our cases illustrate the usability of a new contrast agent and a new imaging strategy for visualizing slow-flow endoleaks that can not be imaged using currently used imaging techniques with conventional contrast agents.