Müller-Wille R, Borgmann T, Wohlgemuth W A, Zeman F, Pfister K, Jung E M, Heiss P, Schreyer A G, Krauss B, Stroszczynski C, Dornia C
Institute of Radiology, University Medical Center Regensburg, Regensburg, Germany,
Eur Radiol. 2014 Oct;24(10):2449-57. doi: 10.1007/s00330-014-3266-y. Epub 2014 Jun 26.
To assess the diagnostic accuracy of dual-energy computed tomography (DECT) for detection of endoleaks and aneurysm sac calcifications after endovascular aneurysm repair (EVAR) using hard plaque imaging algorithms.
One hundred five patients received 108 triple-phase contrast-enhanced CT (non-contrast, arterial and delayed phase) after EVAR. The delayed phase was acquired in dual-energy and post-processed using the standard (HPI-S) and a modified (HPI-M) hard plaque imaging algorithm. The reference standard was determined using the triple-phase CT and contrast-enhanced ultrasound. All images were analysed separately for the presence of endoleaks and calcifications by two independent readers; sensitivity, specificity and interobserver agreement were calculated.
Endoleaks and calcifications were present in 25.9 % (28/108) and 20.4 % (22/108) of images. The HPI-S images had a sensitivity/specificity of 54 %/100 % (reader 1) and 57 %/99 % (reader 2), the HPI-M images of 93 %/92 % (reader 1) and 96 %/92 % (reader 2) for detection of endoleaks. For detection of calcifications HPI-S had a sensitivity/specificity of 91 %/99 % (reader 1) and 95 %/97 % (reader 2), the HPI-M images of 91 %/99 % (reader 1) and 91 %/99 % (reader 2), respectively.
Using HPI-M, DECT enables an accurate diagnosis of endoleaks after EVAR and allows distinguishing between endoleaks and calcifications with high diagnostic accuracy.
• Dual-energy computed tomography allows the diagnosis of aortic pathologies after EVAR. • Hard plaque imaging algorithms can distinguish between endoleaks and aneurysm sac calcifications. • The modified hard plaque imaging algorithm detects endoleaks with high diagnostic accuracy.
使用硬斑块成像算法评估双能计算机断层扫描（DECT）检测血管内动脉瘤修复术（EVAR）后内漏和动脉瘤囊钙化的诊断准确性。
105例患者在EVAR术后接受了108次三相对比增强CT检查（平扫、动脉期和延迟期）。延迟期采用双能扫描并使用标准（HPI-S）和改良（HPI-M）硬斑块成像算法进行后处理。参考标准通过三相CT和对比增强超声确定。两名独立阅片者分别分析所有图像中内漏和钙化的情况；计算敏感性、特异性和观察者间一致性。
25.9%（28/108）的图像存在内漏，20.4%（22/108）的图像存在钙化。HPI-S图像检测内漏的敏感性/特异性，阅片者1为54%/100%，阅片者2为57%/99%；HPI-M图像检测内漏的敏感性/特异性，阅片者1为93%/92%，阅片者2为96%/92%。对于钙化检测，HPI-S的敏感性/特异性阅片者1为91%/99%，阅片者2为95%/97%；HPI-M图像的敏感性/特异性阅片者1和阅片者2均为91%/99%。
使用HPI-M，DECT能够准确诊断EVAR术后的内漏，并能以高诊断准确性区分内漏和钙化。
• 双能计算机断层扫描可诊断EVAR术后的主动脉病变。• 硬斑块成像算法可区分内漏和动脉瘤囊钙化。• 改良的硬斑块成像算法检测内漏具有高诊断准确性。
