Dynamic Radial MR Imaging for Endoleak Surveillance after Endovascular Repair of Abdominal Aortic Aneurysms with Inconclusive CT Angiography: A Prospective Study
Haidara AlmansourMigdat MustafiMario LescanUlrich GrosseMateja AnđićJörg SchmehlChristoph ArtznerGerd GrözingerSven Walter
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Background/Objectives: To assess free-breathing, dynamic radial magnetic resonance angiography (MRA) for detecting endoleaks post-endovascular aortic repair (EVAR) in cases with inconclusive computed tomography angiography (CTA). Methods: This prospective single-center study included 17 participants (mean age, 70 ± 9 years; 13 males) who underwent dynamic radial MRI (Golden-angle RAdial Sparse Parallel-Volumetric Interpolated BrEath-hold, GRASP-VIBE) after inconclusive multiphasic CT for the presence of endoleaks during the follow-up of EVAR-treated abdominal aortic aneurysms. CT and MRI datasets were independently assessed by two radiologists for image quality, diagnostic confidence, and the presence/type of endoleak. Statistical analyses included interrater and intermethod agreement, and diagnostic performance (sensitivity, specificity, area under the curve (AUC)). Results: Subjective image analysis demonstrated good image quality and interrater agreement (k ≥ 0.6) for both modalities, while diagnostic confidence was significantly higher in MRA (p = 0.03). There was significantly improved accuracy for detecting type II endoleaks on MRA (AUC 0.97 [95% CI: 0.87, 1.0]) compared to CTA (AUC 0.66 [95% CI: 0.41, 0.91]; p = 0.03). Although MRA demonstrated higher values for sensitivity, specificity, AUC, and interrater agreement, none of the other types nor the overall detection rate for endoleaks showed differences in the diagnostic performance over CT (p ≥ 0.12). CTA and MRA revealed slight to moderate intermethod concordance in endoleak detection (k = 0.3–0.64). Conclusions: The GRASP-VIBE MRA characterized by high spatial and temporal resolution demonstrates clinical feasibility with good image quality and superior diagnostic confidence. It notably enhances diagnostic performance in detecting and classifying endoleaks, particularly type II, compared to traditional multiphase CTA with inconclusive findings.Keywords:
Computed Tomography Angiography
Magnetic resonance angiography
Concordance
Computed tomography angiography is a new technique that provides high-resolution, three dimensional vascular imaging as well as excellent bone and soft tissue spatial relationships. The purpose of this study was to examine the use of computed tomography angiography in planning upper extremity reconstruction. Seventeen computed tomography angiograms were obtained in 14 patients over a 20-monthperiod. All studies were obtained on an outpatient basis with contrast administered through a peripheral vein. All the studies demonstrated the pertinent anatomy and the intraoperative findings were as demonstrated in all cases. Information from two studies significantly altered pre-operative planning. The average charge for computed tomography angiography was $1,140, compared to $3,900 for traditional angiography.
Computed Tomography Angiography
Surgical Planning
Rotational angiography
Conventional angiography
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Computed Tomography Angiography
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To determine the accuracy of magnetic resonance angiography in assessing patients with cerebrovascular disease, we performed a study comparing the results of conventional cerebral angiography, duplex scanning, and magnetic resonance angiography. From 42 patients, a total of 25 carotid arteries were evaluated by all three techniques. The studies were independently read and sorted into five categories according to the degree of stenosis: 0-15%, normal; 16-49%, mild; 50-79%, moderate; 80-99%, severe; and totally occluded. Magnetic resonance angiography correlated exactly with conventional angiography in 39 arteries (52%); duplex scanning correlated with conventional angiography in 49 cases (65%). Compared with conventional angiography, both magnetic resonance angiography and duplex scanning tended to overread the degree of stenosis. The most critical errors associated with magnetic resonance angiography were three readings of total occlusion in vessels found to be patent on conventional angiograms. Although magnetic resonance angiography offers great hope of providing high-quality imaging of the carotid artery with no risk and at less cost, data from this study suggest that misreading the degree of stenosis, or misinterpreting a stenosis for an occlusion, could lead to errors in clinical decisions. Guidelines for use of magnetic resonance angiography in a clinical setting are offered.
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To determine the accuracy of magnetic resonance angiography in assessing patients with cerebrovascular disease, we performed a study comparing the results of conventional cerebral angiography, duplex scanning, and magnetic resonance angiography.From 42 patients, a total of 25 carotid arteries were evaluated by all three techniques. The studies were independently read and sorted into five categories according to the degree of stenosis: 0-15%, normal; 16-49%, mild; 50-79%, moderate; 80-99%, severe; and totally occluded.Magnetic resonance angiography correlated exactly with conventional angiography in 39 arteries (52%); duplex scanning correlated with conventional angiography in 49 cases (65%). Compared with conventional angiography, both magnetic resonance angiography and duplex scanning tended to overread the degree of stenosis. The most critical errors associated with magnetic resonance angiography were three readings of total occlusion in vessels found to be patent on conventional angiograms.Although mag...
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Conventional angiography
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We read with interest the article by Fukaya et al, “Magnetic Resonance Angiography for Free Fibula Flap Transfer,” in which a significant advancement in imaging technologies prior to perforator flap surgery is described—namely, the identification and analysis of the course of perforating arteries as a tool for preoperative planning.[1] Although magnetic resonance angiography (MRA),[2] computed tomographic angiography (CTA),[3] [4] and conventional angiography have each been used prior to free fibular flap surgery as a tool for mapping the vascular pedicles,[5] Fukaya et al have described advancements in MRA that permit analysis of individual perforators as small as 1 mm in diameter.
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The aim of the study was to compare the detectability of neck vessels with contrast enhanced magnetic resonance angiography (MRA) in the setting of a whole-body MRA and multislice computed tomography angiography (CTA) for preoperative vascular mapping of head and neck. In 20 patients MRA was performed prior to microvascular reconstruction of the mandible with osteomyocutaneous flaps. CTA of the neck served as the method of reference. 1.5 T contrast enhanced magnetic resonance angiograms were acquired to visualize the vascular structures of the neck in the setting of a whole-body MRA examination. 64-slice spiral computed tomography was performed with a dual-phase protocol, using the arterial phase images for 3D CTA reconstruction. Maximum intensity projection was employed to visualize MRA and CTA data. To retrieve differences in the detectability of vessel branches between MRA and CTA, a McNemar test was performed. All angiograms were of diagnostic quality. There were no statistically significant differences between MRA and CTA for the detection of branches of the external carotid artery that are relevant host vessels for microsurgery (p = 0.118). CTA was superior to MRA if all the external carotid artery branches were included (p < 0.001). MRA is a reliable alternative to CTA in vascular mapping of the cervical vasculature for planning of microvascular reconstruction of the mandible. In the setting of whole-body MRA it could serve as a radiation free one-stop-shop tool for preoperative assessment of the arterial system, potentially covering both, the donor and host site in one single examination.
Magnetic resonance angiography
Computed Tomography Angiography
Maximum intensity projection
Spiral computed tomography
Multislice
Surgical Planning
External carotid artery
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Magnetic resonance angiography
Conventional angiography
Computed Tomography Angiography
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Objective To evaluate the application of multi-slice spiral CT and MRA in the diagnosis of aortic dissection.Methods 189 patients of aortic dissection were confirmed by surgery or angiography,the coincidence rate of diagnosis were observed using multi-slice spiral CT angiography(MSCTA),magnetic resonance angiography(MRA)and transthoracic echocardiography(TTE).Results 68 cases of Debakey I type,22 cases of Debakey Ⅱ type,99 cases of Debakey IlI type were confirmed by multi-slice spiral CT angiography(MCTA),magnetic resonance angiography(MRA)and transthoracic echocardiography(TTE),in which multi-slice spiral CT angiography(MSCTA)and magnetic resonance angiography(MRA)diagnosis of aortic dissection and confirmed by surgery or angiography were more in line with rate of 100%.Conclusion Aortic dissection can be confirmed by multi-slice spiral CT or magnetic resonance angiography.Compered with magnetic resonance angiography,multi-slice spiral CT angiography has the short scanning time,and it can reduce the risk of patients with hemodynamic instability.Multi-slice spiral CT angiography in aortic dissection is a safe,rapid,noninvasive and effective diagnostic method.
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Magnetic resonance angiography
Computed Tomography Angiography
Digital subtraction angiography
Neuroradiology
Intermittent claudication
Claudication
Critical limb ischemia
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Background and Objectives Computed tomography angiography represents one of the most important investigation modalities in the diagnosis and follow-up of vascular diseases. We prospectively compare between patients who have had preoperative computed tomography (CT) angiography and others who had not, to analyze the influence of CT angiography on the diagnosis and postoperative outcomes in gunshot cases. Methods A Cohort study to compare between patients who underwent preoperative CT angiography and others who had not, to analyze the influence of CT angiography on the diagnosis and postoperative outcomes in patients who suffer from urgent vascular reconstruction due to gunshot wounds in extremities with concomitant vascular injuries, in the time period from 17 February 2011 to 31 December 2011 in Al-Jalaa Hospital, Benghazi, Libya. Results During the study period, 89 patients were included, of whom 88 (99%) were males and 1 (1%) was female; the mean age was 29.5 years. Patients were arranged into two groups. The first group of 38 patients (43%) were operated urgently without preoperative CT angiographic evaluation. The second group of 51 patients (57%) have had a preoperative CT angiographic evaluation. Conclusion In the light of our study, we favor the immediate operative exploration of gunshot wounds in extremities with concomitant hard signs of vascular injuries without waiting for preoperative CT angiography, thereby minimizing the shock state and ischemic interval. CT angiography may be required for a more stable patient to avoid unnecessary surgical exploration.
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