title: Non-contrast MR imaging for detecting endoleak after abdominal endovascular aortic repair.
abstract: Our aim was to investigate the possibility of ruling out endoleak after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) using non-contrast MRI. Twenty-three patients (20 males, aged 73 ± 8 years) with an EVAR-treated AAA underwent 1.5-T MRI using axial, coronal and sagittal oblique true-FISP sequences. Two blinded and independent readers with 4 (R1) and 2 (R2) years of experience evaluated these images considering an area of even less than 5 mm in diameter with a signal intensity higher than that of normal muscles visible in the excluded aneurysmal sac as a sign of potential endoleak. The final assessment, mainly based on MR angiography and previous examinations, served as reference standard. Out of 23 patients, 13 (57%) were negative for endoleak at final assessment, while the remaining 10 (43%) were positive, with the following type distribution: Ia (n = 4), Ib (n = 2), II (n = 3), and III (n = 1). Sensitivity was 10/10 (100%; CI 95% 69-100%), specificity 7/13 (54%; 25-81%), accuracy 17/23 (74%; 52-90%), PPV 10/16 (63%; 35-85%) and NPV 7/7 (100%; 59-100%) for R1; 9/10 (90%; 56-100%), 8/13 (62%; 32-86%), 17/23 (74%; 52-90%), 9/14 (64%; 35-8%), and 8/9 (89%; 52-100%) for R2, respectively. Inter-reader Cohen κ was 0.810. A negative non-contrast true-FISP MR study can be used to rule out endoleak after EVAR of AAA. This hypothesis may contribute to the reduction of ionizing radiation exposure and contrast material administration for monitoring patients with an EVAR-treated AAA.
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy.
authors.forename: Elda C
authors.initials: EC
authors.lastname: Resta
authors.forename: Francesco
authors.initials: F
authors.lastname: Secchi
authors.forename: Antonello
authors.initials: A
authors.lastname: Giardino
authors.forename: Veronica G
authors.initials: VG
authors.lastname: Nardella
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.forename: Nicola
authors.initials: N
authors.lastname: Flor
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects*; D057867:Endoleak / Q000175:diagnosis* / Q000209:etiology; D057510:Endovascular Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000592:standards; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012015:Reference Standards; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome