Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study
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...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-12-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/1/20 |
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| author | Francesco Secchi Davide Capra Caterina Beatrice Monti Nazanin Mobini Maria Del Mar Galimberti Ortiz Santi Trimarchi Daniela Mazzaccaro Paolo Righini Giovanni Nano Francesco Sardanelli |
| author_facet | Francesco Secchi Davide Capra Caterina Beatrice Monti Nazanin Mobini Maria Del Mar Galimberti Ortiz Santi Trimarchi Daniela Mazzaccaro Paolo Righini Giovanni Nano Francesco Sardanelli |
| author_sort | Francesco Secchi |
| collection | DOAJ |
| description | 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 (<i>p</i> > 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 (<i>p</i> = 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. |
| first_indexed | 2024-03-11T10:05:11Z |
| format | Article |
| id | doaj.art-a953d5f857e840f3bc23e5e01b5bbcf7 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T10:05:11Z |
| publishDate | 2022-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-a953d5f857e840f3bc23e5e01b5bbcf72023-11-16T15:07:44ZengMDPI AGDiagnostics2075-44182022-12-011312010.3390/diagnostics13010020Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR StudyFrancesco Secchi0Davide Capra1Caterina Beatrice Monti2Nazanin Mobini3Maria Del Mar Galimberti Ortiz4Santi Trimarchi5Daniela Mazzaccaro6Paolo Righini7Giovanni Nano8Francesco Sardanelli9Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, ItalyDepartment of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, ItalyPostgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, ItalyDepartment of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, ItalyPostgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, ItalyDepartment of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, ItalyUnit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, ItalyUnit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, ItalyDepartment of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, ItalyDepartment of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, ItalyWe 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 (<i>p</i> > 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 (<i>p</i> = 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.https://www.mdpi.com/2075-4418/13/1/20computed tomography angiographymagnetic resonance imagingendovascular proceduresendoleakaortic aneurysm |
| spellingShingle | Francesco Secchi Davide Capra Caterina Beatrice Monti Nazanin Mobini Maria Del Mar Galimberti Ortiz Santi Trimarchi Daniela Mazzaccaro Paolo Righini Giovanni Nano Francesco Sardanelli Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study Diagnostics computed tomography angiography magnetic resonance imaging endovascular procedures endoleak aortic aneurysm |
| title | Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study |
| title_full | Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study |
| title_fullStr | Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study |
| title_full_unstemmed | Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study |
| title_short | Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study |
| title_sort | safe follow up after endovascular aortic repair with unenhanced mri the safevar study |
| topic | computed tomography angiography magnetic resonance imaging endovascular procedures endoleak aortic aneurysm |
| url | https://www.mdpi.com/2075-4418/13/1/20 |
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