Type 2 Endoleaks: The Diagnostic Performance of Non-Specialized Readers on Arterial and Venous Phase Multi-Slice CT Angiography

• Published in: PloS one 2016-03, Vol.11 (3), p.e0149725-e0149725
• Main Authors: Nolz, Richard, Ulrika, Asenbaum, Furtner, Julia, Woitek, Ramona, Unterhumer, Sylvia, Wibmer, Andreas, Prusa, Alexander, Loewe, Christian, Schoder, Maria
• Format: Article
• Language: English
• Subjects: Abdomen; Aged; Aged, 80 and over; Aneurysm; Aneurysms; Angiography; Angiography - instrumentation; Angiography - methods; Arteries - pathology; Biology and Life Sciences; Blood vessels; Computed tomography; Data processing; Diagnostic systems; Endoleak - diagnosis; Feeding; Female; Humans; Male; Medical diagnosis; Medical imaging; Medicine and Health Sciences; Middle Aged; Patients; Physical Sciences; Radiation; Radiation Dosage; Radiology; Readers; Reproducibility of Results; Research and Analysis Methods; Retrospective Studies; Sensitivity and Specificity; Tomography, X-Ray Computed - instrumentation; Tomography, X-Ray Computed - methods; Vascular surgery; Veins - pathology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0149725

To define the diagnostic precision of non-specialized readers in the detection of type 2 endoleaks (T2EL) in arterial versus venous phase acquisitions, and to evaluate an approach for radiation dose reduction. The pre-discharge and final follow-up multi-slice CT angiographies of 167 patients were retrospectively analyzed. Image data were separated into an arterial and a venous phase reading set. Two radiology residents assessed the reading sets for the presence of a T2EL, feeding vessels, and aneurysm sac size. Findings were compared with a standard of reference established by two experts in interventional radiology. The effective dose was calculated. Overall, experts detected 131 T2ELs, and 331 feeding vessels in 334 examinations. Persistent T2ELs causing aneurysm sac growth > 5 mm were detected in 20 patients. Radiation in arterial and venous phases contributed to a mean of 58.6% and 39.0% of the total effective dose. Findings of reader 1 and 2 showed comparable sensitivities in arterial sets of 80.9 versus 85.5 (p = 0.09), and in venous sets of 73.3 versus 79.4 (p = 0.15), respectively. Reader 1 and 2 achieved a significant higher detection rate of feeding vessels with arterial compared to venous set (p = 0.04, p < 0.01). Both readers correctly identified T2ELs with growing aneurysm sac in all cases, independent of the acquisition phase. Arterial acquisitions enable non-specialized readers an accurate detection of T2ELs, and a significant better identification of feeding vessels. Based on our results, it seems reasonable to eliminate venous phase acquisitions.