Dynamic, Time-Resolved Computed Tomography Angiography Technique to Characterize Aortic Endoleak Type, Inflow and Provide Guidance for Targeted Treatment

Marton Berczeli, Alan B. Lumsden, Su Min Chang, Charudatta S. Bavare, Ponraj Chinnadurai

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Purpose: To illustrate dynamic, time-resolved CTA (d-CTA) imaging technique in characterizing aortic endoleak type/inflow using quantitative parameters and its value in providing image guidance for targeted treatment approach. Technique: Dedicated endoleak protocol involved acquiring multiple time-resolved contrast enhanced scans using third-generation CT scanner (Somatom Force®, Siemens Healthineers). Parameters such as scan field of view (FOV), kV, number/timing of scans were customized based on patient’s body-mass-index, timing bolus, and prior imaging findings. D-CTA image datasets were evaluated qualitatively and quantitatively using time-attenuation curves (TAC) analysis after motion correction using a dedicated software (syngo.via®, Siemens). D-CTA findings from 4 illustrative cases demonstrating type I, type II (inferior mesenteric and lumbar artery inflow), and type III endoleak were illustrated. TAC analysis with time to peak parameter enabled better characterization of endoleak type and inflow. During endoleak intervention, target vessels from d-CTA images were electronically annotated and overlaid on fluoroscopy using 2D−3D image fusion to provide image guidance for targeted treatment. Conclusion: D-CTA imaging with TAC analysis characterizes aortic endoleak type and inflow, in addition to providing image guidance for targeted endoleak treatment. Such dynamic, time-resolved imaging techniques may provide further insights into understanding aortic endoleak that remains an Achilles heel for endovascular aortic aneurysm repair.

Original languageEnglish (US)
Pages (from-to)11-22
Number of pages12
JournalJournal of Endovascular Therapy
Volume29
Issue number1
DOIs
StatePublished - Feb 2022

Keywords

  • EVAR
  • aortic endoleak
  • delayed CT imaging
  • dynamic CTA imaging
  • endoleak embolization
  • endovascular aneurysm repair
  • image fusion
  • post EVAR surveillance
  • time-resolve CTA
  • triphasic CT imaging

ASJC Scopus subject areas

  • Surgery
  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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