基于影像学的腹主动脉瘤腔内修复术后持续性Ⅱ型内漏的预测因素
Imaging-Based Predictors of Persistent Type II Endoleak After Endovascular Abdominal Aortic Aneurysm Repair.
作者信息
Mursalin Rafael, Sakamoto Ichiro, Nagayama Hiroki, Sueyoshi Eijun, Tanigawa Kazuyoshi, Miura Takashi, Uetani Masataka
机构信息
1 Department of Radiology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
2 Department of Cardiovascular Surgery, Graduate School of Medicine, Nagasaki University, Nagasaki, Japan.
出版信息
AJR Am J Roentgenol. 2016 Jun;206(6):1335-40. doi: 10.2214/AJR.15.15254. Epub 2016 Apr 4.
OBJECTIVE
The purpose of this study is to determine the imaging-based parameters associated with the occurrence of persistent type II endoleaks after endovascular abdominal aortic aneurysm repair.
MATERIALS AND METHODS
We reviewed the imaging and clinical data for 47 patients with early-onset type II endoleak after endovascular repair. Various predictors of persistent type II endoleaks were analyzed on the basis of preoperative CT findings. In addition, the appearance time of endoleak cavity on the operative angiogram and the relative attenuation of the endoleak cavity in the arterial phase image from the first postoperative CT study were analyzed.
RESULTS
The early-onset type II endoleak resolved spontaneously in 22 patients (i.e., the transient group), whereas it was identified on CT studies of the remaining 25 patients 6 months after endovascular repair (i.e., the persistent group). The appearance time of the endoleak cavity on angiographic examination was significantly shorter in the persistent group than in the transient group (mean [± SD] appearance time, 4.7 ± 0.3 s vs 8.8 ± 0.3 s). The relative attenuation of the endoleak cavity on the first postoperative CT scan was also significantly higher in the persistent group than in the transient group (mean, 0.70 ± 0.03 vs 0.30 ± 0.04). For each parameter, ROC analysis revealed the following cutoff points for predicting persistent type II endoleak: 6 seconds for the appearance time of the endoleak cavity (sensitivity, 88%; specificity, 86%), and 0.5 for the relative attenuation of the endoleak cavity (sensitivity, 80%; specificity, 95%). Evaluation of other imaging-based parameters revealed no statistically significant differences between the groups.
CONCLUSION
The appearance time of the endoleak cavity on the final operative angiogram and the attenuation of the endoleak cavity on the first postoperative CT scan can be strong imaging-based predictors of persistent type II endoleak.
目的
本研究旨在确定与血管腔内腹主动脉瘤修复术后持续性Ⅱ型内漏发生相关的基于影像学的参数。
材料与方法
我们回顾了47例血管腔内修复术后早期发生Ⅱ型内漏患者的影像学和临床资料。基于术前CT表现分析了持续性Ⅱ型内漏的各种预测因素。此外，分析了手术血管造影上内漏腔的出现时间以及术后首次CT研究动脉期图像中内漏腔的相对衰减情况。
结果
22例患者（即短暂性组）的早期Ⅱ型内漏自发消失，而其余25例患者在血管腔内修复术后6个月的CT检查中仍发现有内漏（即持续性组）。持续性组血管造影检查时内漏腔的出现时间明显短于短暂性组（平均[±标准差]出现时间，4.7±0.3秒对8.8±0.3秒）。持续性组术后首次CT扫描时内漏腔的相对衰减也明显高于短暂性组（平均，0.70±0.03对0.30±0.04）。对于每个参数，ROC分析得出预测持续性Ⅱ型内漏的以下截断点：内漏腔出现时间为6秒（敏感性，88%；特异性，86%），内漏腔相对衰减为0.5（敏感性，80%；特异性，95%）。对其他基于影像学的参数进行评估，发现两组之间无统计学显著差异。
结论
最终手术血管造影上内漏腔的出现时间以及术后首次CT扫描时内漏腔的衰减可作为持续性Ⅱ型内漏强有力的基于影像学的预测指标。
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