Visualizing type IV endoleak using magnetic resonance imaging with a blood pool contrast agent
Sandra A Cornelissen1, Hence J Verhagen, Mathias Prokop
1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. sandrac@isi.uu.nl
Journal of Vascular Surgery
|April 3, 2008
Summary
Graft porosity in Excluder endografts may prevent aneurysm shrinkage. A new MRI technique visualized these slow-flow endoleaks, offering a novel imaging strategy for previously undetectable issues.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Biomaterials
Background:
- Endovascular aneurysm repair (EVAR) aims for aneurysm sac shrinkage.
- The original Excluder device is associated with suboptimal shrinkage in some patients.
- Graft porosity is suspected but historically unvisualized as a cause.
Observation:
- Three patients treated with the original Excluder device showed no aneurysm shrinkage within two years.
- Standard CT angiography and late-phase CT scans did not reveal endoleaks.
- A novel imaging approach using late-phase MRI with a blood pool agent was employed.
Findings:
- The new MRI strategy successfully visualized graft porosity in the studied patients.
- Slow-flow endoleaks, previously undetectable, were identified.
- This confirms graft porosity as a potential factor limiting aneurysm sac regression.
Implications:
- This imaging technique can reveal occult endoleaks related to graft porosity.
- It provides a new method to assess device-related complications in EVAR.
- Understanding graft porosity may lead to improved endograft design and patient selection.
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