Bertrand-Grenier Antony, Zehtabi Fatemeh, Lerouge Sophie, Alturkistani Husain, Kauffmann Claude, Bodson-Clermont Paule, Salazkin Igor, Héon Hélène, Cloutier Guy, Soulez Gilles
Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM), 900 rue St Denis, Montréal, Québec, H2X 0A9, Canada.
Laboratoire de biorhéologie et d'ultrasonographie médicale, CRCHUM, Montréal, Québec, Canada.
Eur Radiol Exp. 2018 Oct 10;2(1):28. doi: 10.1186/s41747-018-0059-0.
To evaluate residual endoleak and thrombus organisation with shear wave imaging (SWI) after endoleak embolisation through an animal study.
This prospective experimental study involved eight dogs with creation of 16 iliac aneurysms and type I endoleak after endovascular aneurysm repair (EVAR). Embolisation agents were injected into the sac to seal endoleak. SWI and colour flow Doppler ultrasound (DUS) were performed at implantation, one week, and one and three months after implantation; for three dogs, SWI and DUS were also performed six months after implantation. Digital subtraction angiography and contrast-enhanced computed tomography were performed at sacrifice. Macroscopic and histopathological analyses were processed to identify regions of interest (ROIs) for endoleak, fresh thrombus, organised thrombus and embolisation agent, where SWI elasticity moduli were compared.
At sacrifice, nine aneurysms had residual endoleak, while seven were sealed. Ten had a fresh and 15 had an organised thrombus. SWI was able to detect all endoleaks, including two cases undetected with DUS. Elasticity moduli of 0.2 kPa ± 0.1 kPa (mean ± SD), 9.5 kPa ± 3.3 kPa, 48.1 kPa ± 21.3 kPa and 44.9 kPa ± 23.7 kPa were found in the ROIs positioned in endoleaks, fresh thrombi, organised thrombi and embolisation agent, respectively. Elasticity values of endoleak and fresh thrombus were lower than those of organised thrombi and embolisation agent (p < 0.001). Stiffness of fresh thrombus at one week (8.7 kPa ± 3.6 kPa) increased at three months (30.2 kPa ± 13.8 kPa), indicating thrombus maturation (p < 0.001).
In a dog model of iliac EVAR, SWI was able to identify endoleak, thrombus maturation and embolising agents after endoleak embolisation.
通过动物研究，利用剪切波成像（SWI）评估内漏栓塞术后的残余内漏及血栓机化情况。
这项前瞻性实验研究纳入了8只犬，通过血管内动脉瘤修复术（EVAR）制造了16个髂动脉瘤及I型内漏。向瘤腔内注入栓塞剂以封闭内漏。在植入时、植入后1周、1个月和3个月进行SWI及彩色多普勒超声（DUS）检查；对3只犬在植入后6个月也进行了SWI及DUS检查。处死动物时进行数字减影血管造影及增强CT检查。进行大体及组织病理学分析以确定内漏、新鲜血栓、机化血栓及栓塞剂的感兴趣区域（ROI），并比较这些区域的SWI弹性模量。
处死动物时，9个动脉瘤存在残余内漏，7个已封闭。10个有新鲜血栓，15个有机化血栓。SWI能够检测到所有内漏，包括2例DUS未检测到的病例。在内漏、新鲜血栓、机化血栓及栓塞剂的ROI中，弹性模量分别为0.2 kPa±0.1 kPa（均值±标准差）、9.5 kPa±3.3 kPa、48.1 kPa±21.3 kPa和44.9 kPa±23.7 kPa。内漏及新鲜血栓的弹性值低于机化血栓及栓塞剂（p<0.001）。新鲜血栓在1周时的硬度为8.7 kPa±3.6 kPa，在3个月时增加至30.2 kPa±13.8 kPa，表明血栓成熟（p<0.001）。
在犬髂动脉EVAR模型中，SWI能够在内漏栓塞术后识别内漏、血栓成熟及栓塞剂。
