From the Department of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland (A.L., T.S., V.M., L.J., M.E., A.K., H.A., A.E.); Department of Radiology, Spital Interlaken, Spitäler fmi AG, Unterseen, Switzerland (M.E.); and Department of Radiology, Kantonsspital Baden, Baden, Switzerland (A.E.).
Radiol Cardiothorac Imaging. 2024 Apr;6(2):e230217. doi: 10.1148/ryct.230217.
Purpose To compare image quality, diagnostic performance, and conspicuity between single-energy and multi-energy images for endoleak detection at CT angiography (CTA) after endovascular aortic repair (EVAR). Materials and Methods In this single-center prospective randomized controlled trial, individuals undergoing CTA after EVAR between August 2020 and May 2022 were allocated to imaging using either low-kilovolt single-energy images (SEI; 80 kV, group A) or low-kiloelectron volt virtual monoenergetic images (VMI) at 40 and 50 keV from multi-energy CT (80/Sn150 kV, group B). Scan protocols were dose matched (volume CT dose index: mean, 4.5 mGy ± 1.8 [SD] vs 4.7 mGy ± 1.3, = .41). Contrast-to-noise ratio (CNR) was measured. Two expert radiologists established the reference standard for the presence of endoleaks. Detection and conspicuity of endoleaks and subjective image quality were assessed by two different blinded radiologists. Interreader agreement was calculated. Nonparametric statistical tests were used. Results A total of 125 participants (mean age, 76 years ± 8; 103 men) were allocated to groups A ( = 64) and B ( = 61). CNR was significantly lower for 40-keV VMI (mean, 19.1; = .048) and 50-keV VMI (mean, 16.8; < .001) as compared with SEI (mean, 22.2). In total, 45 endoleaks were present (A: 23 vs B: 22). Sensitivity for endoleak detection was higher for SEI (82.6%, 19 of 23; = .88) and 50-keV VMI (81.8%, 18 of 22; = .90) as compared with 40-keV VMI (77.3%, 17 of 22). Specificity was comparable among groups (SEI: 92.7%, 38 of 41; both VMI energies: 92.3%, 35 of 38; = .99), with an interreader agreement of 1. Conspicuity of endoleaks was comparable between SEI (median, 2.99) and VMI (both energies: median, 2.87; = .04). Overall subjective image quality was rated significantly higher for SEI (median, 4 [IQR, 4-4) as compared with 40 and 50 keV (both energies: median, 4 [IQR, 3-4]; < .001). Conclusion SEI demonstrated higher image quality and comparable diagnostic accuracy as compared with 50-keV VMI for endoleak detection at CTA after EVAR. Aneurysms, CT, CT Angiography, Vascular, Aorta, Technology Assessment, Multidetector CT, Abdominal Aortic Aneurysms, Endoleaks, Perigraft Leak . © RSNA, 2024.
目的 比较血管内修复（EVAR）后 CT 血管造影（CTA）中使用单能量和多能量图像检测内漏的图像质量、诊断性能和显示度。
材料与方法 本单中心前瞻性随机对照试验纳入 2020 年 8 月至 2022 年 5 月期间行 EVAR 后行 CTA 的患者，将其随机分配至低千伏单能量图像（SEI；80 kV，A 组）或低千伏虚拟单能量图像（VMI）组（40 和 50 keV，80/Sn150 kV，B 组）。扫描方案进行了剂量匹配（容积 CT 剂量指数：均值，4.5 mGy ± 1.8 [SD] vs 4.7 mGy ± 1.3， =.41）。测量对比噪声比（CNR）。两位专家放射科医师建立了内漏的参考标准。两位不同的盲法放射科医师评估了内漏的检测和显示度以及主观图像质量。计算了读者间的一致性。使用非参数统计检验。
结果 共纳入 125 例患者（平均年龄，76 岁 ± 8；103 例男性），分配至 A 组（ = 64）和 B 组（ = 61）。与 SEI 相比，40 keV VMI（均值，19.1； =.048）和 50 keV VMI（均值，16.8； <.001）的 CNR 显著更低。共发现 45 例内漏（A 组：23 例；B 组：22 例）。SEI（82.6%，23 例中的 19 例； =.88）和 50 keV VMI（81.8%，22 例中的 18 例； =.90）对内漏检测的敏感性高于 40 keV VMI（77.3%，22 例中的 17 例）。组间的特异性相当（SEI：92.7%，41 例中的 38 例；两种 VMI 能量：92.3%，38 例中的 35 例； =.99），读者间的一致性为 1。SEI（中位数，2.99）和 VMI（两种能量：中位数，2.87； =.04）对内漏的显示度相当。总体而言，SEI 的主观图像质量评分（中位数，4 [IQR，4-4）显著高于 40 和 50 keV（两种能量：中位数，4 [IQR，3-4]； <.001）。
结论 与 50 keV VMI 相比，SEI 在 EVAR 后 CTA 检测内漏方面表现出更高的图像质量和相当的诊断准确性。
血管成像术，数字减影；体层摄影术，X 线计算机；血管；主动脉；技术评估，多探测器计算机；腹主动脉瘤；内漏；血管修复术；支架
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