Laboratory of Clinical Imaging Processing, Centre hospitalier de l'Université de Montréal (CHUM) Research Center (CRCHUM), Montréal, Québec, Canada.
Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Canada.
Eur Radiol. 2020 Jul;30(7):3879-3889. doi: 10.1007/s00330-020-06739-3. Epub 2020 Mar 4.
To investigate the feasibility of shear wave sonoelastography (SWS) for endoleak detection and thrombus characterization of abdominal aortic aneurysm (AAA) after endovascular repair (EVAR).
Participants who underwent EVAR were prospectively recruited between November 2014 and March 2016 and followed until March 2019. Elasticity maps of AAA were computed using SWS and compared to computed tomography angiography (CTA) and color Doppler ultrasound (CDUS). Two readers, blinded to the CTA and CDUS results, reviewed elasticity maps and B-mode images to detect endoleaks. Three or more CTAs per participant were analyzed: pre-EVAR, baseline post-EVAR, and follow-ups. The primary endpoint was endoleak detection. Secondary endpoints included correlation between total thrombus elasticity, proportion of fresh thrombus, and aneurysm growth between baseline and reference CTAs. A 3-year follow-up was made to detect missed endoleaks, EVAR complication, and mortality. Data analyses included Cohen's kappa; sensitivity, specificity, and positive predictive value (PPV); Pearson coefficient; and Student's t tests.
Seven endoleaks in 28 participants were detected by the two SWS readers (k = 0.858). Sensitivity of endoleak detection with SWS was 100%; specificity and PPV averaged 67% and 50%, respectively. CDUS sensitivity was estimated at 43%. Aneurysm growth was significantly greater in the endoleak group compared to sealed AAAs. No correlation between growth and thrombus elasticity or proportion of fresh thrombus in AAAs was found. No new endoleaks were observed in participants with SWS negative studies.
SWS has the potential to detect endoleaks in AAA after EVAR with comparable sensitivity to CTA and superior sensitivity to CDUS.
• Dynamic elastography with shear wave sonoelastography (SWS) detected 100% of endoleaks in abdominal aortic aneurysm (AAA) follow-up that were identified by a combination of CT angiography (CTA) and color Doppler ultrasound (CDUS). • Based on elasticity maps, SWS differentiated endoleaks from thrombi within the aneurysm sac (p < 0.001). • After 3-year follow-up, no new endoleaks were observed in SWS negative examinations.
研究剪切波弹性成像（SWS）在血管内修复（EVAR）后检测腹主动脉瘤（AAA）内漏和血栓特征的可行性。
2014 年 11 月至 2016 年 3 月期间前瞻性招募接受 EVAR 的参与者，并随访至 2019 年 3 月。使用 SWS 计算 AAA 的弹性图，并与计算机断层血管造影（CTA）和彩色多普勒超声（CDUS）进行比较。两位读者对 CTA 和 CDUS 结果不知情，对弹性图和 B 型图像进行了回顾，以检测内漏。每位患者分析 3 次以上 CTA：术前、术后基线和随访。主要终点是内漏检测。次要终点包括基线和参考 CTA 之间总血栓弹性、新鲜血栓比例和动脉瘤生长的相关性。进行了 3 年的随访，以检测漏诊的内漏、EVAR 并发症和死亡率。数据分析包括 Cohen's kappa；敏感性、特异性和阳性预测值（PPV）；Pearson 系数；和学生 t 检验。
两名 SWS 读者共检出 28 例患者中的 7 例内漏（k=0.858）。SWS 检测内漏的敏感性为 100%；特异性和 PPV 平均分别为 67%和 50%。CDUS 的敏感性估计为 43%。与封闭的 AAA 相比，内漏组的动脉瘤生长明显更大。在 AAA 中，生长与血栓弹性或新鲜血栓比例之间没有相关性。在 SWS 阴性研究的参与者中未发现新的内漏。
SWS 具有检测 EVAR 后 AAA 内漏的潜力，其敏感性与 CTA 相当，敏感性优于 CDUS。
• 剪切波弹性成像（SWS）的动态弹性成像检测到 100%的腹主动脉瘤（AAA）随访中的内漏，这些内漏是通过 CT 血管造影（CTA）和彩色多普勒超声（CDUS）相结合发现的。• 根据弹性图，SWS 区分了内漏和瘤腔内的血栓（p<0.001）。• 在 3 年的随访中，在 SWS 阴性检查中未发现新的内漏。
