Endoleak detection using single-acquisition split-bolus dual-energy computer tomography (DECT)

• Published in: European radiology 2017-04, Vol.27 (4), p.1622-1630
• Main Authors: Javor, D., Wressnegger, A., Unterhumer, S., Kollndorfer, K., Nolz, R., Beitzke, D., Loewe, C.
• Format: Article
• Language: English
• Subjects: Abdomen; Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal - surgery; Aortic aneurysms; Computed Tomography; Contrast Media - administration & dosage; Coronary vessels; Diagnostic Radiology; Drug Administration Schedule; Endoleak - diagnostic imaging; Endoleak - etiology; Endovascular Procedures - adverse effects; Endovascular Procedures - methods; Energy; Female; Humans; Imaging; Internal Medicine; Interventional Radiology; Magnetic Resonance Angiography - methods; Male; Medical imaging; Medicine; Medicine & Public Health; Middle Aged; Neuroradiology; Patients; Prospective Studies; Radiation; Radiation Dosage; Radiology; Retrospective Studies; Tomography; Tomography, X-Ray Computed - methods; Ultrasound
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-016-4480-6

Objectives To assess a single-phase, dual-energy computed tomography (DECT) with a split-bolus technique and reconstruction of virtual non-enhanced images for the detection of endoleaks after endovascular aneurysm repair (EVAR). Methods Fifty patients referred for routine follow-up post-EVAR CT and a history of at least one post-EVAR follow-up CT examination using our standard biphasic (arterial and venous phase) routine protocol (which was used as the reference standard) were included in this prospective trial. An in-patient comparison and an analysis of the split-bolus protocol and the previously used double-phase protocol were performed with regard to differences in diagnostic accuracy, radiation dose, and image quality. Results The analysis showed a significant reduction of radiation dose of up to 42 %, using the single-acquisition split-bolus protocol, while maintaining a comparable diagnostic accuracy (primary endoleak detection rate of 96 %). Image quality between the two protocols was comparable and only slightly inferior for the split-bolus scan (2.5 vs. 2.4). Conclusions Using the single-acquisition, split-bolus approach allows for a significant dose reduction while maintaining high image quality, resulting in effective endoleak identification. Key Points • A single-acquisition, split-bolus approach allows for a significant dose reduction . • Endoleak development is the most common complication after endovascular aortic repair (EVAR) . • CT angiography is the imaging modality of choice for aortic aneurysm evaluation .