We aimed to investigate whether unenhanced magnetic resonance imaging (MRI) could represent a safe and highly sensitive tool for endoleak screening in patients treated with endovascular aneurysm repair (EVAR) using computed tomography angiography (CTA) as a reference standard. Patients who underwent CTA for EVAR follow-up at our institution were prospectively enrolled. All MRI examinations were performed with a 1.5 T unit. The true-FISP and HASTE sequences of the MRI scans were assessed for the presence of hyperintensity within the aneurysm sac outside the graft, whereas phase-contrast through-plane sequences were used for blood flow quantification. We included 45 patients, 5 (11%) of whom were female. The median age was 73 years (IQR 68-78 years). Among our patients, 19 (42%) were positive for endoleaks at CTA, of whom 13 (68%) had type II endoleaks and 6 (32%) had type I endoleaks. There were no significant differences in age, sex, aneurysm type, prosthesis type, or contrast-to-noise ratio between hyperintensity and thrombus between patients with and without endoleaks (p > 0.300). The combined evaluation of true-FISP and HASTE yielded 100% sensitivity (95% CI: 79-100%) and 19% specificity (95% CI: 7-40%). Patients with a positive CTA had a median thrombus flow of 0.06 L/min (IQR 0.03-0.23 L/min), significantly greater than that of patients with a negative CTA (p = 0.007). Setting a threshold at 0.01 L/min, our MRI protocol yielded 100% sensitivity, 56% specificity, and an AUC of 0.76 (95% CI 0.60-0.91). In conclusion, unenhanced MRI has perfect sensitivity for endoleak detection, although with subpar specificity that could be improved with phase-contrast flow analysis.

Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study / F. Secchi, D. Capra, C.B. Monti, N. Mobini, M.D.M.G. Ortiz, S. Trimarchi, D. Mazzaccaro, P. Righini, G. Nano, F. Sardanelli. - In: DIAGNOSTICS. - ISSN 2075-4418. - 13:1(2023 Jan), pp. 20.1-20.10. [10.3390/diagnostics13010020]

Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study

F. Secchi
Primo
;
D. Capra
Secondo
;
C.B. Monti
;
N. Mobini;M.D.M.G. Ortiz;S. Trimarchi;D. Mazzaccaro;G. Nano
Penultimo
;
F. Sardanelli
Ultimo
2023

Abstract

We aimed to investigate whether unenhanced magnetic resonance imaging (MRI) could represent a safe and highly sensitive tool for endoleak screening in patients treated with endovascular aneurysm repair (EVAR) using computed tomography angiography (CTA) as a reference standard. Patients who underwent CTA for EVAR follow-up at our institution were prospectively enrolled. All MRI examinations were performed with a 1.5 T unit. The true-FISP and HASTE sequences of the MRI scans were assessed for the presence of hyperintensity within the aneurysm sac outside the graft, whereas phase-contrast through-plane sequences were used for blood flow quantification. We included 45 patients, 5 (11%) of whom were female. The median age was 73 years (IQR 68-78 years). Among our patients, 19 (42%) were positive for endoleaks at CTA, of whom 13 (68%) had type II endoleaks and 6 (32%) had type I endoleaks. There were no significant differences in age, sex, aneurysm type, prosthesis type, or contrast-to-noise ratio between hyperintensity and thrombus between patients with and without endoleaks (p > 0.300). The combined evaluation of true-FISP and HASTE yielded 100% sensitivity (95% CI: 79-100%) and 19% specificity (95% CI: 7-40%). Patients with a positive CTA had a median thrombus flow of 0.06 L/min (IQR 0.03-0.23 L/min), significantly greater than that of patients with a negative CTA (p = 0.007). Setting a threshold at 0.01 L/min, our MRI protocol yielded 100% sensitivity, 56% specificity, and an AUC of 0.76 (95% CI 0.60-0.91). In conclusion, unenhanced MRI has perfect sensitivity for endoleak detection, although with subpar specificity that could be improved with phase-contrast flow analysis.
computed tomography angiography; magnetic resonance imaging; endovascular procedures; endoleak; aortic aneurysm
Settore MED/22 - Chirurgia Vascolare
gen-2023
12-dic-2022
Article (author)
File in questo prodotto:
File Dimensione Formato  
diagnostics-13-00020-v2 (1).pdf

accesso aperto

Descrizione: Article
Tipologia: Publisher's version/PDF
Dimensione 2.73 MB
Formato Adobe PDF
2.73 MB Adobe PDF Visualizza/Apri
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/986409
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 3
  • ???jsp.display-item.citation.isi??? 2
social impact