Imaging Follow-up of Endovascular Repair of Type B Aortic Dissection with Dual-Source,Dual-Energy CT and Late Delayed-Phase Scans |
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| Affiliation: | 1. Department of Radiology and Medical Imaging, University of Virginia Health System, Box 800170, Lee Street, Charlottesville, VA 22908;2. Department of Biostatistics and Epidemiology, University of Virginia Health System, Box 800170, Lee Street, Charlottesville, VA 22908;1. Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University Hospital, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany;2. Diagnostic and Interventional Radiology Department, Cairo University Hospital, Cairo University, Cairo;3. Diagnostic and Interventional Radiology Department, Alexandria University Hospital, Alexandria University, Alexandria;4. Diagnostic and Interventional Radiology Department, Mansoura University Hospital, Mansoura University, Daqahlia, Egypt;1. Department of Radiology, Kenyatta National Hospital, University of Nairobi, P.O. Box 19676–00202, Nairobi, Kenya;2. Department of Vascular and Interventional Radiology, Hadassah University Hospital, Jerusalem, Israel;1. Center for Endovascular Therapy, Kobe University Hospital, Kobe, Japan;2. Department of Radiology, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan;3. Cardiovascular Division, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan;4. Vascular and Endovascular Division, Department of Surgery, Cipto Mangunkusumo Hospital, Faculty of Medicine University of Indonesia, Jakarta, Indonesia;1. Department of Radiology, Beth Israel Medical Center, First Avenue at 16th Street, New York, NY 10003;2. Department of Radiology, St. Luke’s-Roosevelt Hospital Center, New York, New York;1. Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642;2. Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642 |
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| Abstract: | PurposeTo evaluate the diagnostic performance of dual-energy (DE) computed tomography (CT) after thoracic endovascular aortic repair (TEVAR) of type B dissection, and to investigate the value of late delayed (LD) acquisition in endoleak detection and false lumen patency assessment.Materials and MethodsTwenty-four patients with TEVAR for type B dissection underwent 53 tripe-phase CT examinations. Single-source unenhanced acquisition was followed by single-source arterial-phase and DE LD phase (300-s delay) imaging. Virtual noncontrast images were generated from DE acquisition. Two blinded radiologists retrospectively evaluated the cases in three reading sessions: session A (triphasic protocol), session B (virtual noncontrast and arterial phase), and session C (virtual noncontrast and arterial and LD phases). Endoleak detection accuracy during sessions B and C compared with session A (reference standard) was investigated. False lumen patency was assessed. Effective radiation dose was calculated.ResultsSession A revealed 37 endoleaks in 30 of 53 studies (56.6%). Session B revealed 31 of the 37 endoleaks, with one false-positive case, 83.8% sensitivity, 95.8% specificity, 79.3% negative predictive value, and 96.9% positive predictive value. Session C correctly depicted all 37 endoleaks, with one false-positive case, 100% sensitivity, 95.8% specificity, 100% negative predictive value, and 97.4% positive predictive value. Underestimation of false lumen patency was found in session B (P = .013). Virtual noncontrast imaging resulted in 17% radiation exposure reduction.ConclusionsVirtual noncontrast imaging can replace standard unenhanced images in follow-up after TEVAR of type B dissection, thus reducing radiation dose. Delayed-phase imaging is valuable in low-flow endoleaks detection and false lumen patency assessment. |
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