Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study

Georg Apfaltrer; Francesco Lavra; U. Joseph Schoepf; Marco Scarabello; Ricardo Yamada; Marly van Assen; Akos Varga-Szemes; Brian E. Jacobs; Maximilian J. Bauer; William T. Greenberg; Marcelo Guimaraes; Luca Saba; Carlo N. De Cecco

doi:10.1371/journal.pone.0245134

Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study

Georg Apfaltrer, Francesco Lavra, U. Joseph Schoepf^*, Marco Scarabello, Ricardo Yamada, Marly van Assen, Akos Varga-Szemes, Brian E. Jacobs, Maximilian J. Bauer, William T. Greenberg, Marcelo Guimaraes, Luca Saba, Carlo N. De Cecco

^*Corresponding author for this work

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Abstract

Objectives

To assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR).

Material and methods

Twenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers.

Results

In total, 19 patients (18 males, median age 74 years [70.5-75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5-5] vs. 4.5 [4-5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1-1] vs 1.5 [1.5-1.5], respectively; p

Conclusions

Quantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.

Original language	English
Article number	0245134
Number of pages	14
Journal	PLoS ONE
Volume	16
Issue number	1
DOIs	https://doi.org/10.1371/journal.pone.0245134
Publication status	Published - 7-Jan-2021

Keywords

CT ANGIOGRAPHY
BLOOD-FLOW
CLASSIFICATION

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Apfaltrer, G., Lavra, F., Schoepf, U. J., Scarabello, M., Yamada, R., van Assen, M., Varga-Szemes, A., Jacobs, B. E., Bauer, M. J., Greenberg, W. T., Guimaraes, M., Saba, L., & De Cecco, C. N. (2021). Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study. PLoS ONE, 16(1), Article 0245134. https://doi.org/10.1371/journal.pone.0245134

@article{25ac03aa1ad34991a3ebecac1a9e436f,

title = "Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study",

abstract = "ObjectivesTo assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR).Material and methodsTwenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers.ResultsIn total, 19 patients (18 males, median age 74 years [70.5-75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5-5] vs. 4.5 [4-5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1-1] vs 1.5 [1.5-1.5], respectively; pConclusionsQuantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.",

keywords = "CT ANGIOGRAPHY, BLOOD-FLOW, CLASSIFICATION",

author = "Georg Apfaltrer and Francesco Lavra and Schoepf, {U. Joseph} and Marco Scarabello and Ricardo Yamada and {van Assen}, Marly and Akos Varga-Szemes and Jacobs, {Brian E.} and Bauer, {Maximilian J.} and Greenberg, {William T.} and Marcelo Guimaraes and Luca Saba and {De Cecco}, {Carlo N.}",

year = "2021",

month = jan,

day = "7",

doi = "10.1371/journal.pone.0245134",

language = "English",

volume = "16",

journal = "PLoS ONE",

issn = "1932-6203",

publisher = "PUBLIC LIBRARY SCIENCE",

number = "1",

}

Apfaltrer, G, Lavra, F, Schoepf, UJ, Scarabello, M, Yamada, R, van Assen, M, Varga-Szemes, A, Jacobs, BE, Bauer, MJ, Greenberg, WT, Guimaraes, M, Saba, L & De Cecco, CN 2021, 'Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study', PLoS ONE, vol. 16, no. 1, 0245134. https://doi.org/10.1371/journal.pone.0245134

TY - JOUR

T1 - Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair

T2 - A feasibility study

AU - Apfaltrer, Georg

AU - Lavra, Francesco

AU - Schoepf, U. Joseph

AU - Scarabello, Marco

AU - Yamada, Ricardo

AU - van Assen, Marly

AU - Varga-Szemes, Akos

AU - Jacobs, Brian E.

AU - Bauer, Maximilian J.

AU - Greenberg, William T.

AU - Guimaraes, Marcelo

AU - Saba, Luca

AU - De Cecco, Carlo N.

PY - 2021/1/7

Y1 - 2021/1/7

N2 - ObjectivesTo assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR).Material and methodsTwenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers.ResultsIn total, 19 patients (18 males, median age 74 years [70.5-75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5-5] vs. 4.5 [4-5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1-1] vs 1.5 [1.5-1.5], respectively; pConclusionsQuantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.

AB - ObjectivesTo assess the feasibility of quantitative analysis of dynamic computed tomography angiography (dCTA) for the detection of endoleaks in patients who underwent endovascular repair of abdominal aortic aneurysms (EVAR).Material and methodsTwenty patients scheduled for contrast-enhanced CT angiography (CTA) of the abdominal aorta post-EVAR were prospectively enrolled. All patients received a standard triphasic CTA protocol, followed by an additional dCTA. The dCTA acquisition enabled reconstruction of color-coded maps depicting blood perfusion and a dCTA dataset of the aneurysm sac. Observers assessed the dCTA and dynamic CT perfusion (dCTP) images for the detection of endoleaks, establishing diagnostic confidence based on a modified 5-point Likert scale. An index was calculated for the ratio between the endoleak and aneurysm sac using blood flow for dCTP and Hounsfield units (HU) for dCTA. The Wilcoxon test compared the endoleak index and the diagnostic confidence of the observers.ResultsIn total, 19 patients (18 males, median age 74 years [70.5-75.7]) were included for analysis. Nine endoleaks were detected in 7 patients using triphasic CTA as the reference standard. There was complete agreement for endoleak detection between the two techniques on a per-patient basis. Both dCTA and dCTP identified an additional endoleak in one patient. The diagnostic confidence using dCTP for detection of endoleaks was not significantly superior to dCTA (5.0 [5-5] vs. 4.5 [4-5], respectively; p = 0.11); however, dCTP demonstrated superior diagnostic confidence for endoleak exclusion compared to dCTA (1.0 [1-1] vs 1.5 [1.5-1.5], respectively; pConclusionsQuantitative analysis of dCTP imaging can aid in the detection of endoleaks and demonstrates a higher endoleak detection rate than triphasic CTA, as well as a strong correlation with visual assessment of dCTA images.

KW - CT ANGIOGRAPHY

KW - BLOOD-FLOW

KW - CLASSIFICATION

U2 - 10.1371/journal.pone.0245134

DO - 10.1371/journal.pone.0245134

M3 - Article

SN - 1932-6203

VL - 16

JO - PLoS ONE

JF - PLoS ONE

IS - 1

M1 - 0245134

ER -

Quantitative analysis of dynamic computed tomography angiography for the detection of endoleaks after abdominal aorta aneurysm endovascular repair: A feasibility study

Abstract

Keywords

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