Endograft position and endoleak detection after endovascular abdominal aortic repair with low-field tiltable MRI: a
Jordy K van Zandwijk1,2, Richte C L Schuurmann3,4, Bennie Ten Haken5
1Magnetic Detection & Imaging, Technical Medical Centre, University of Twente, Enschede, The Netherlands. j.k.vanzandwijk@utwente.nl.
Background:
Abdominal aortic endoleaks after endovascular aneurysm repair might be position-dependent, therefore undetectable using supine imaging. We aimed to determine the feasibility and benefit of using a low-field tiltable magnetic resonance imaging (MRI) scanner allowing to study patients who can be imaged in both supine and upright positions of endoleaks.
Methods:
Ten EVAR patients suspected of endoleak based on ultrasound examination were prospectively included. MRI in upright and supine positions was compared with routine supine computed tomography angiography (CTA). Analysis was performed through (1) subjective image quality assessment by three observers, (2) landmark registration between MRI and CTA scans, (3) Euclidean distances between renal and endograft landmarks, and (4) evaluation of endoleak detection on MRI by a consensus panel. Statistical analysis was performed by one-way repeated measures analysis of variance.
Results:
The image quality of upright/supine MRI was inferior compared to CTA. Median differences in both renal and endograft landmarks were approximately 6-7 mm between upright and supine MRI and 5-6 mm between supine MRI and CTA. In the proximal sealing zone of the endograft, no differences were found among all three scan types (p = 0.264). Endoleak detection showed agreement between MRI and CTA in 50% of the cases, with potential added value in only one patient.
Conclusions:
The benefit of low-field upright MRI for endoleak detection was limited. While MRI assessment was non-inferior to standard CTA in detecting endoleaks in selected cases, improved hardware and sequences are needed to explore the potential of upright MRI in patients with endoleaks.
Relevance Statement:
Upright low-field MRI has limited clinical value in detecting position-dependent endoleaks; improvements are required to fulfil its potential as a complementary modality in this clinical setting.
Key Points:
• Upright MRI shows potential for imaging endoleaks in aortic aneurysm patients in different positions. • The image quality of upright MRI is inferior to current techniques. • Upright MRI complements CTA, but lacks accurate deformation measurements for clinical use. • Advancements in hardware and imaging sequences are needed to fully utilise upright MRI capabilities.
More Related Videos
13:48Reduction of Radiation Exposure during Endovascular Treatment of Peripheral Arterial Disease Combining Fiber Optic RealShape Technology and Intravascular Ultrasound
Published on: April 21, 2023
07:12Author Spotlight: Using Point-of-Care Ultrasound for Comprehensive Evaluation of the Abdominal Aorta
Published on: September 8, 2023