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Francois CJ, Skulborstad EP, Majdalany BS, Chandra A, Collins JD, Farsad K, Gerhard-Herman MD, Gornik HL, Kendi AT, Khaja MS, Lee MH, Sutphin PD, Kapoor BS, Kalva SP. ACR Appropriateness Criteria ® Abdominal Aortic Aneurysm: Interventional Planning and Follow-Up. J Am Coll Radiol 2018; 15:S2-S12. [DOI: 10.1016/j.jacr.2018.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/04/2018] [Indexed: 12/17/2022]
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Nguyen V, Leiner T, Hellenthal F, Backes W, Wishaupt M, van der Geest R, Heeneman S, Kooi M, Schurink G. Abdominal Aortic Aneurysms with High Thrombus Signal Intensity on Magnetic Resonance Imaging are Associated with High Growth Rate. Eur J Vasc Endovasc Surg 2014; 48:676-84. [DOI: 10.1016/j.ejvs.2014.04.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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Müller-Eschner M, Müller T, Biesdorf A, Wörz S, Rengier F, Böckler D, Kauczor HU, Rohr K, von Tengg-Kobligk H. 3D morphometry using automated aortic segmentation in native MR angiography: an alternative to contrast enhanced MRA? Cardiovasc Diagn Ther 2014; 4:80-7. [PMID: 24834406 DOI: 10.3978/j.issn.2223-3652.2013.10.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 10/28/2013] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Native-MR angiography (N-MRA) is considered an imaging alternative to contrast enhanced MR angiography (CE-MRA) for patients with renal insufficiency. Lower intraluminal contrast in N-MRA often leads to failure of the segmentation process in commercial algorithms. This study introduces an in-house 3D model-based segmentation approach used to compare both sequences by automatic 3D lumen segmentation, allowing for evaluation of differences of aortic lumen diameters as well as differences in length comparing both acquisition techniques at every possible location. METHODS AND MATERIALS Sixteen healthy volunteers underwent 1.5-T-MR Angiography (MRA). For each volunteer, two different MR sequences were performed, CE-MRA: gradient echo Turbo FLASH sequence and N-MRA: respiratory-and-cardiac-gated, T2-weighted 3D SSFP. Datasets were segmented using a 3D model-based ellipse-fitting approach with a single seed point placed manually above the celiac trunk. The segmented volumes were manually cropped from left subclavian artery to celiac trunk to avoid error due to side branches. Diameters, volumes and centerline length were computed for intraindividual comparison. For statistical analysis the Wilcoxon-Signed-Ranked-Test was used. RESULTS Average centerline length obtained based on N-MRA was 239.0±23.4 mm compared to 238.6±23.5 mm for CE-MRA without significant difference (P=0.877). Average maximum diameter obtained based on N-MRA was 25.7±3.3 mm compared to 24.1±3.2 mm for CE-MRA (P<0.001). In agreement with the difference in diameters, volumes obtained based on N-MRA (100.1±35.4 cm(3)) were consistently and significantly larger compared to CE-MRA (89.2±30.0 cm(3)) (P<0.001). CONCLUSIONS 3D morphometry shows highly similar centerline lengths for N-MRA and CE-MRA, but systematically higher diameters and volumes for N-MRA.
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Affiliation(s)
- Matthias Müller-Eschner
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Tobias Müller
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Andreas Biesdorf
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Stefan Wörz
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Fabian Rengier
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Dittmar Böckler
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Hans-Ulrich Kauczor
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Karl Rohr
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Hendrik von Tengg-Kobligk
- 1 Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Germany ; 2 Department of Radiology, German Cancer Research Center, Heidelberg, Germany ; 3 Dept. Bioinformatics and Functional Genomics, Biomedical Computer Vision Group, University of Heidelberg, BIOQUANT, IPMB, and DKFZ Heidelberg; 4 Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Germany ; 5 Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
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Piffaretti G, Caronno R, Tozzi M, Lomazzi C, Rivolta N, Castelli P. Endovascular versus open repair of ruptured abdominal aortic aneurysms. Expert Rev Cardiovasc Ther 2014; 4:839-52. [PMID: 17173500 DOI: 10.1586/14779072.4.6.839] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although major improvement has occurred to make elective repair of abdominal aortic aneurysms a safe procedure, the incidence of ruptured abdominal aortic aneurysms and mortality rates are still disappointing. Endovascular abdominal aortic aneurysm repair has produced quantum changes in aneurysm treatment. The successful application of the endovascular approach for the treatment of abdominal aortic aneurysms in the elective setting has prompted a strong interest regarding its possible use in dealing with the long-standing challenge of a ruptured abdominal aortic aneurysm. Since the first report, several centers have reported results and a wide spectrum of opinion regarding its application, with special consideration to logistical and practical barriers for appropriate utilization. The purpose of this article is to review all the available literature on the endovascular repair of ruptured abdominal aortic aneurysms and to analyze the most recent trends in their management, with special consideration given to comparing results of conventional and endovascular approaches.
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Affiliation(s)
- Gabriele Piffaretti
- University of Insubria, Vascular Surgery-Department of Surgery, Viale Borri 57 21100, Varese, Italy.
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5
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Molecular imaging of experimental abdominal aortic aneurysms. ScientificWorldJournal 2013; 2013:973150. [PMID: 23737735 PMCID: PMC3655677 DOI: 10.1155/2013/973150] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/19/2013] [Indexed: 11/18/2022] Open
Abstract
Current laboratory research in the field of abdominal aortic aneurysm (AAA) disease often utilizes small animal experimental models induced by genetic manipulation or chemical application. This has led to the use and development of multiple high-resolution molecular imaging modalities capable of tracking disease progression, quantifying the role of inflammation, and evaluating the effects of potential therapeutics. In vivo imaging reduces the number of research animals used, provides molecular and cellular information, and allows for longitudinal studies, a necessity when tracking vessel expansion in a single animal. This review outlines developments of both established and emerging molecular imaging techniques used to study AAA disease. Beyond the typical modalities used for anatomical imaging, which include ultrasound (US) and computed tomography (CT), previous molecular imaging efforts have used magnetic resonance (MR), near-infrared fluorescence (NIRF), bioluminescence, single-photon emission computed tomography (SPECT), and positron emission tomography (PET). Mouse and rat AAA models will hopefully provide insight into potential disease mechanisms, and the development of advanced molecular imaging techniques, if clinically useful, may have translational potential. These efforts could help improve the management of aneurysms and better evaluate the therapeutic potential of new treatments for human AAA disease.
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Philip F, Shishehbor MH, Desai MY, Schoenhagen P, Ellis S, Kapadia SR. Characterization of internal pudendal artery atherosclerosis using aortography and multi-detector computed angiography. Catheter Cardiovasc Interv 2013; 82:E516-21. [DOI: 10.1002/ccd.24804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 12/06/2012] [Accepted: 01/01/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Femi Philip
- Department of Cardiovascular Medicine; Heart & Vascular Institute; Cleveland Clinic Cleveland; Ohio
| | - Mehdi H. Shishehbor
- Department of Cardiovascular Medicine; Heart & Vascular Institute; Cleveland Clinic Cleveland; Ohio
| | - Milind Y. Desai
- Department of Cardiovascular Medicine; Heart & Vascular Institute; Cleveland Clinic Cleveland; Ohio
| | - Paul Schoenhagen
- Department of Cardiovascular Medicine; Heart & Vascular Institute; Cleveland Clinic Cleveland; Ohio
| | - Stephen Ellis
- Department of Cardiovascular Medicine; Heart & Vascular Institute; Cleveland Clinic Cleveland; Ohio
| | - Samir R. Kapadia
- Department of Cardiovascular Medicine; Heart & Vascular Institute; Cleveland Clinic Cleveland; Ohio
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Abstract
Abdominal aortic aneurysms (AAA) affect 5% of the population in developed countries and are characterized by progressive aortic dilatation with an unpredictable time course. This condition is more common in men than in women, and in smokers than in nonsmokers. If left untreated, AAA can result in aortic rupture and death. Pathologically, aortic extracellular matrix degradation, inflammation, and neovascularization are hallmarks of AAA. Diagnosis of AAA and subsequent surveillance utilize established aortic imaging methods, such as ultrasound, CT, and MRI. More-speculative diagnostic approaches include molecular and cellular imaging methods that interrogate the underlying pathological processes at work within the aneurysm. In this Review, we explore the current diagnostic and therapeutic strategies for the management of AAA. We also describe the diagnostic potential of new imaging techniques and therapeutic potential of new treatments for the management of small AAA.
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Endovascular aneurysm repair: current and future status. Cardiovasc Intervent Radiol 2008; 31:451-9. [PMID: 18231829 DOI: 10.1007/s00270-008-9295-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Revised: 12/01/2007] [Accepted: 12/06/2007] [Indexed: 10/22/2022]
Abstract
Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future.
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Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, Hiratzka LF, Murphy WR, Olin JW, Puschett JB, Rosenfield KA, Sacks D, Stanley JC, Taylor LM, White CJ, White J, White RA, Antman EM, Smith SC, Adams CD, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): A Collaborative Report from the American Association for Vascular Surgery/Society for Vascular Surgery,⁎Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease). J Am Coll Cardiol 2006. [DOI: 10.1016/j.jacc.2006.02.024] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Atar E, Belenky A, Hadad M, Ranany E, Baytner S, Bachar GN. MR Angiography for Abdominal and Thoracic Aortic Aneurysms: Assessment Before Endovascular Repair in Patients with Impaired Renal Function. AJR Am J Roentgenol 2006; 186:386-93. [PMID: 16423943 DOI: 10.2214/ajr.04.0449] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the study was to establish the feasibility of using MR angiography as the sole imaging technique before endovascular repair of abdominal or thoracic aortic aneurysms and to compare preprocedural measurements by MR angiography and digital subtraction angiography in patients with impaired renal function. CONCLUSION MR angiography appears to be effective and reliable for use as the sole imaging method before endovascular repair of aortic aneurysms in patients with renal impairment.
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Affiliation(s)
- Eli Atar
- Department of Radiology, Interventional Radiology Unit, Rabin Medical Center, Beilinson Campus, Petah-Tiqva 49100, Israel
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Raman VK, Karmarkar PV, Guttman MA, Dick AJ, Peters DC, Ozturk C, Pessanha BSS, Thompson RB, Raval AN, DeSilva R, Aviles RJ, Atalar E, McVeigh ER, Lederman RJ. Real-time magnetic resonance-guided endovascular repair of experimental abdominal aortic aneurysm in swine. J Am Coll Cardiol 2005; 45:2069-77. [PMID: 15963411 PMCID: PMC1317097 DOI: 10.1016/j.jacc.2005.03.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2004] [Revised: 02/20/2005] [Accepted: 03/01/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES This study tested the hypotheses that endografts can be visualized and navigated in vivo solely under real-time magnetic resonance imaging (rtMRI) guidance to repair experimental abdominal aortic aneurysms (AAA) in swine, and that MRI can provide immediate assessment of endograft apposition and aneurysm exclusion. BACKGROUND Endovascular repair for AAA is limited by endoleak caused by inflow or outflow malapposition. The ability of rtMRI to image soft tissue and flow may improve on X-ray guidance of this procedure. METHODS Infrarenal AAA was created in swine by balloon overstretch. We used one passive commercial endograft, imaged based on metal-induced MRI artifacts, and several types of homemade active endografts, incorporating MRI receiver coils (antennae). Custom interactive rtMRI features included color coding the catheter-antenna signals individually, simultaneous multislice imaging, and real-time three-dimensional rendering. RESULTS Eleven repairs were performed solely using rtMRI, simultaneously depicting the device and soft-tissue pathology during endograft deployment. Active devices proved most useful. Intraprocedural MRI provided anatomic confirmation of stent strut apposition and functional corroboration of aneurysm exclusion and restoration of laminar flow in successful cases. In two cases, there was clear evidence of contrast accumulation in the aneurysm sac, denoting endoleak. CONCLUSIONS Endovascular AAA repair is feasible under rtMRI guidance. Active endografts facilitate device visualization and complement the soft tissue contrast afforded by MRI for precise positioning and deployment. Magnetic resonance imaging also permits immediate post-procedural anatomic and functional evaluation of successful aneurysm exclusion.
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Affiliation(s)
| | - Parag V. Karmarkar
- From the Cardiovascular Branch and the
- Laboratory of Cardiac Energetics, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland; and the
| | - Michael A. Guttman
- Laboratory of Cardiac Energetics, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland; and the
| | | | - Dana C. Peters
- Laboratory of Cardiac Energetics, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland; and the
| | | | | | - Richard B. Thompson
- Laboratory of Cardiac Energetics, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland; and the
| | | | | | | | - Ergin Atalar
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland. Supported by NIH Z01-HL005062-01CVB (to Dr. Lederman). Drs. Raman and Karmarkar contributed equally to this work
| | - Elliot R. McVeigh
- Laboratory of Cardiac Energetics, Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, Maryland; and the
| | - Robert J. Lederman
- From the Cardiovascular Branch and the
- Reprint requests and correspondence: Dr. Robert J. Lederman, Cardiovascular Branch, Clinical Research Program, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10, Room 2c713, Bethesda, Maryland 20892-1538. E-mail:
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Gawenda M, Gossmann A, Krüger K, Zaehringer M, Hahn M, Wassmer G, Brunkwall J. Comparison of Magnetic Resonance Imaging and Computed Tomography of 8 Aortic Stent-Graft Models. J Endovasc Ther 2004; 11:627-34. [PMID: 15615553 DOI: 10.1583/03-1130mr.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To report the systematic comparison of magnetic resonance imaging (MRI) with contrast-enhanced computed tomography (CT) for evaluating 8 different aortic stent-graft models. METHODS MR angiography (MRA) was performed using a 1.5-T whole body system within 2 days of a CT examination (4 detector row scanner) on 8 patients with one of these stent-graft models: AneuRx, Endofit, PowerLink, Excluder, LifePath, Talent, Vanguard, or Zenith. Using a 4-point scale (maximum score 112 points), 4 independent readers (1 vascular surgeon and 3 radiologists) rated the impact of stent-related artifacts on the diagnostic quality of each imaging method for 28 parameters: length, diameter, collateral aortic side branches, stent-graft prostheses, and contrast. Each examiner also scored his personal diagnostic confidence with each stent-graft model. RESULTS The scores for diagnostic confidence in the CT imaging were 4 points for each stent-graft, with the exception of the LifePath (3 points). The diagnostic confidence in the MR images was mainly poor, with a median score of only 1; however, 3 stent-grafts (AneuRx, Excluder, and Vanguard) received > or =3 points. The total scores for comparative assessment were significantly different (p<0.05) between CT imaging (111.5) and MR (58.5). CT studies of all stent-grafts received >101 points, while only 3 devices acquired >80 points (AneuRx, Excluder, and Vanguard). Bland-Altman analysis showed that the reliability of the 4 readers was higher using the CT method. The total assessment scores of the stent-graft systems were related only on the different imaging methods (p<0.0001) and not to the different readers (p=0.983). CONCLUSIONS CT and MRI are fast, reliable means of providing all relevant information for stent-graft surveillance. Of 8 different stent-graft models, only 3 could be adequately assessed by MRA. Therefore, the potential advantages of the MR technique (e.g., use of minimally nephrotoxic contrast media, lack of ionizing radiation) are available only to a small proportion of patients.
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Affiliation(s)
- Michael Gawenda
- Division of Vascular Surgery, University of Cologne, Germany.
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Goyen M, Debatin JF. Gadopentetate dimeglumine-enhanced three-dimensional MR-angiography: dosing, safety, and efficacy. J Magn Reson Imaging 2004; 19:261-73. [PMID: 14994293 DOI: 10.1002/jmri.20005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Noninvasiveness, inherent three-dimensionality allowing reformations in any desired plane, and safe contrast agents, coupled with high diagnostic accuracy have driven the rise in popularity of contrast-enhanced MR angiography (CE-MRA) within the medical community. Reflecting its dominant market share as a paramagnetic contrast agent, gadopentetate dimeglumine (Gd-DTPA) has been used for the majority of clinically-performed MRA exams. Over the period January 1994 to February 2002, a total of 172 original studies describing the use of gadolinium-enhanced MRA in more than three human subjects were identified. Of these, 117 described the use of Gd-DTPA as the contrast agent for MRA. A total of 4046 subjects who received Gd-DTPA for MRA are described in these studies. Analysis of these data demonstrate Gd-DTPA to be a safe contrast agent for MRA when applied in a dose ranging from 0.1 to 0.3 mmol/kg of bodyweight. The documented clinical results show Gd-DTPA to be efficacious in the assessment of the arterial system. The effectiveness of Gd-DTPA-enhanced MRA extends beyond the detection, localization, and characterization of arterial disease, and encompasses choice and planning of appropriate therapy, as well as evaluation of therapeutic effectiveness.
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Affiliation(s)
- Mathias Goyen
- Department of Diagnostic and Interventional Radiology, University Hospital Essen, Essen, Germany.
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Abstract
Patients with aortic aneurysms and renal insufficiency are at an increased risk when conventional imaging modalities (contrast enhancing computed tomography and arteriography) are used for aortic endograft design. Magnetic resonance imaging (MRI) provides a nonionizing, noninvasive alternative to standard measurement techniques. Reliable diameter and length measurements can be obtained with MRI at a computer workstation without the use of iodinated radiologic contrast agents. The authors describe their experience with the use of magnetic resonance angiography as the sole imaging modality for aortic endograft design. Although not without limitations, MRI can be an effective measurement tool, particularly in patients who are at high risk of complications related to conventional imaging.
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Affiliation(s)
- David G Neschis
- Division of Vascular Surgery, University of Maryland Medical Center, 22 S. Greene Street, Room N4W66, Baltimore, MD 21201 USA
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Izzillo R, Cassagnes L, Boutekadjirt R, Garcier JM, Cluzel P, Boyer L. Quand, comment et pourquoi réaliser une imagerie d’un anévrisme de l’aorte abdominale ? ACTA ACUST UNITED AC 2004; 85:870-82. [PMID: 15243362 DOI: 10.1016/s0221-0363(04)97693-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Usually atherosclerotic in origin, aneurysms of the abdominal aorta (AAA) tend to involve the infrarenal aorta. Their biphasic exponential growth pattern, initially slow then accelerated, results in a risk of rupture. Surgical management is recommended for aneurysm diameters of 45-50mm or for growth rates more than 5mm in 6 Months. Imaging is useful for detection and follow-up of nonsurgical aneurysms, presurgical evaluation of aneurysms, and postsurgical follow-up. Frequently asymptomatic, AAA frequently is an incidental finding at the time of abdominal US. The size of the aneurysm sac, the presence of a neck and the size of the iliac arteries are assessed at the time of initial US detection. US is sufficient for follow-up of small aneurysms. Cross sectional imaging evaluation is necessary when surgery is contemplated. Readily available, multidetector row CT scanners with advanced image post-processing capabilities provide all the necessary information prior to surgical or endovascular management: evaluation of the aneurysm sac and neck, iliac and visceral arteries, and adjacent organs. Angiography with graduated catheters remains sometimes indicated. MR angiography provides results similar to CT but is less readily available and is usually reserved for patients with contraindication to iodinated contrast material. While follow-up imaging after surgical management is seldom performed, it is mandatory after endovascular management and includes KUB, Doppler US and CT or MR angiography.
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Affiliation(s)
- R Izzillo
- Service de Radiologie, La Pitié Salpétrière, Paris
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Slovut DP, Ofstein LC, Bacharach JM. Endoluminal AAA repair using intravascular ultrasound for graft planning and deployment: a 2-year community-based experience. J Endovasc Ther 2003; 10:463-75. [PMID: 12932157 DOI: 10.1177/152660280301000311] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To examine the effectiveness of intravascular ultrasound (IVUS) and digital subtraction angiography (DSA) for preoperative planning and intraoperative deployment of stent-grafts to treat abdominal aortic aneurysms. METHODS One hundred seventy patients (143 men; mean age 73.6+/-7.2 years, range 51-89) underwent successful DSA and IVUS to determine suitability for stent-graft repair. Patients subsequently received the AneuRx (n=157) or Ancure (n=13) device; intraprocedural IVUS was used to survey the proximal endograft for proper apposition to the aortic wall. RESULTS Reliable preoperative IVUS measurements were obtained in all patients. Plaque morphology was assessed in 140 (82.3%) aortic necks; in 36 (25.7%), preoperative IVUS showed high-grade atherosclerotic plaque in the nonaneurysmal abdominal aortic neck. The procedure was successful in 168 (98.8%) cases (1 [0.6%] acute conversion and 1 access failure). There were 2 (1.2%) periprocedural deaths related to bowel ischemia. Four (2.3%) patients developed graft occlusion/kinking and 2 (1.2%) developed renal failure requiring dialysis within 30 days. Multivariate logistic regression analysis revealed that female gender (p=0.0247), a short nonaneurysmal aortic neck (p=0.0185), and presence of high-grade atherosclerotic plaque (p=0.0185) correlated with major acute complications. Over a mean 10.4-month follow-up (range 1-25), 11 patients died of unrelated causes; there was no known AAA rupture or device failure. The Kaplan-Meier estimate of survival at 1 year was 91.0%+/-2.8%. Sixteen (9.4%) patients underwent 17 secondary procedures for endoleak or graft limb occlusion at a mean 5.4 months after stent-graft repair (freedom from secondary intervention at 1 year 86.5%+/-3.2%). CONCLUSIONS Our findings suggest that IVUS may identify patients at increased risk of major adverse complications following endovascular repair. The combination of IVUS and DSA for endoluminal stent-graft planning and placement provides excellent short- and mid-term patient outcomes.
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Affiliation(s)
- David P Slovut
- Department of Cardiology, Mount Sinai Medical Center, New York, New York, USA.
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Slovut DP, Ofstein LC, Bacharach JM. Endoluminal AAA Repair Using Intravascular Ultrasound for Graft Planning and Deployment:A 2-Year Community-Based Experience. J Endovasc Ther 2003. [DOI: 10.1583/1545-1550(2003)010<0463:earuiu>2.0.co;2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lutz AM, Willmann JK, Pfammatter T, Lachat M, Wildermuth S, Marincek B, Weishaupt D. Evaluation of aortoiliac aneurysm before endovascular repair: comparison of contrast-enhanced magnetic resonance angiography with multidetector row computed tomographic angiography with an automated analysis software tool. J Vasc Surg 2003; 37:619-27. [PMID: 12618702 DOI: 10.1067/mva.2003.143] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to assess accuracy and reliability of a volumetric analysis of abdominal aneurysms on the basis of multidetector row computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) with a commercially available automated vessel analysis software program. MATERIALS AND METHODS Twenty patients with abdominal aortic aneurysms underwent preoperative CTA and MRA before endovascular repair. Postdeployment CTA was performed in 15 of these 20 patients (75%). All preoperative CTA and MRA and postdeployment CTA data sets were analyzed with an automated software tool. The length of the stent grafts on postdeployment CTA was measured and compared with the true length of the primary component. Two readers independently evaluated 13 vessel parameters on preoperative CTA and MRA, which are considered to be important in planning stent graft deployment. RESULTS With the automated analysis software tool, all measurements could be performed on either CTA or MRA data sets. There was no statistically significant difference between postdeployment measurements of stent graft length on CTA and the true dimensions of the implanted stent grafts. Interobserver agreement for all of the measurements with either CTA or MRA was good to excellent (interclass coefficient, 0.71 to 0.99) with only minimal mean differences of measured dimensions between both readers (range, -2.0 to +2.3 mm, Bland-Altman). Intermodality agreement between CTA and MRA was good to excellent (interclass coefficient, 0.62 to 0.98) with small mean differences of measured dimensions between both methods (range, -4.1 to +2.1 mm, Bland-Altman). CONCLUSION Volumetric measurement with an automated analysis software tool allows a fast, precise, and reliable noninvasive preoperative determination of all aortic dimensions on the basis of either CTA or MRA data sets.
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Affiliation(s)
- Amelie M Lutz
- Institute of Diagnostic Radiology, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland
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20
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Hinchliffe RJ, Braithwaite BD, Hopkinson BR. The endovascular management of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 2003; 25:191-201. [PMID: 12623329 DOI: 10.1053/ejvs.2002.1846] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Endovascular aneurysm repair (EVAR) is a controversial technique, which remains the subject of a number of prospective randomised trials. Although questions remain regarding its long-term durability objective evidence exists which demonstrates its reduced physiological impact compared with conventional open repair. If this technique could be used in patients with ruptured abdominal aortic aneurysm (AAA) it may reduce the high peri-operative mortality. A review of the literature identified a limited experience with EVAR of ruptured AAA. Only a small number of case series with selected patients exist. The majority of patients were haemodynamically stable. However, the selective use of aortic occlusion balloons allowed successful endovascular management in a small number of unstable cases. All investigators had access to an "off the shelf" endovascular stent-graft (EVG). Per-operative mortality ranged from 9 to 45% and may reflect increasing experience and patient selection. A number of patients who underwent successful EVAR were turned down for open repair. A number of important lessons have been learned from these studies but questions remain regarding patient suitability and staffing issues. If these difficulties can be surmounted then the technique may offer an alternative to open repair.
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21
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Kim J, Prince MR, Zabih R, Bezanson J, Watts R, Erel HE, Wang Y. Automatic selection of mask and arterial phase images for temporally resolved MR digital subtraction angiography. Magn Reson Med 2002; 48:1004-10. [PMID: 12465110 DOI: 10.1002/mrm.10358] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
For time-resolved background-subtracted contrast-enhanced magnetic resonance angiography, the bright and sparse arterial signal allows unique identification of contrast bolus arrival in the arteries. This article presents an automatic filtering algorithm using such arterial characterization for selecting arterial phase images and mask images to generate an optimal summary arteriogram. A paired double-blinded comparison demonstrated that this automatic algorithm is as effective as the manual process.
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Affiliation(s)
- Junhwan Kim
- Department of Computer Science, Cornell University, New York, New York, USA.
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22
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Abstract
Although the technical success of stent-graft implantation is established and relatively safe, data on the long-term safety and efficacy of endovascular repair are just emerging. Because several late complications of aortic stent-graft placement have been observed, life-long follow-up remains essential. Imaging methods form an integral part of every stage of endovascular aortic aneurysm repair. The current imaging strategy should include initial plain films, CT angiography, and color-coded Duplex sonography. Plain films are an excellent means to detect migration, angulation, kinking, and structural changes of the stent mesh, including material fatigue, at follow-up. Helical CT angiography is considered a potentially revolutionary method for the noninvasive complete postprocedural assessment of aortic sten-grafting. Current data justify the use of biphasic C angiography as the postprocedural imaging technique of choice in most patients [118]. Ultrasound offers the advantages of low cost and lack of radiation exposure. High-quality ultrasound reliably excludes endoleaks in patients after stent-grafting of AAAs. There is a substantial variability, however, in measuring the diameter of aneurysm sacs; thus, confirmation using an alternative study is prudent in cases that demonstrate a significant change in size during follow-up. MR angiography serves as an attractive alternative to CT angiography in patients with impaired renal function or known allergic reaction to iodinated contrast media. With current techniques, the visualization of aortic stent-grafts (with the exception of stainless-steel-based devices) is sufficient with MR angiography. There is evidence that MR imaging is superior to CT angiography in detecting small type 2 endoleaks or for excluding retrograde perfusion in patients with suspected endotension. The role of diagnostic catheter angiography is limited to assessment of vascular pathways in equivocal cases or for suspected endotension. Currently, a consensus view about postprocedural management after aortic stent-graft implantation is lacking. The authors propose performing a baseline CT angiography at discharge and a biphasic CT angiography and Duplex ultrasound scan at three months. In patients with no evidence of an endoleak, CT angiography, plain film and Duplex sonography (abdomen) should be repeated every year after endovascular repair. If an endoleak is present at follow-up, immediate appropriate treatment should be initiated.
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Kawanishi Y, Lee KS, Kimura K, Kojima K, Yamamoto A, Numata A. Feasibility of multi-slice computed tomography in the diagnosis of arteriogenic erectile dysfunction. BJU Int 2001; 88:390-5. [PMID: 11564028 DOI: 10.1046/j.1464-410x.2001.02316.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare computed tomography (CT) angiography (CTA) obtained by multi-slice CT (a new minimally invasive method) with the current standard of arterial imaging, digital subtraction angiography (DSA), in diagnosing arteriogenic erectile dysfunction (ED). PATIENTS AND METHODS Twenty-one patients with suspected arteriogenic ED underwent DSA and CTA after providing informed consent. Prostaglandin E1 was injected into the penile cavernosal body and then non-ionic contrast medium was rapidly infused into the antecubital vein. The DSA and CTA images were diagnosed as showing a normal or abnormal status by three reviewers independently. CTA was undertaken on an outpatient basis but DSA required hospitalization. RESULTS In the 42 internal pudendal arteries, DSA showed 28 normal and 14 impaired arteries; CTA showed 21 normal arteries and 21 occlusions. The CTA image correlated closely with the diagnosis of stenosis or occlusion in internal pudendal arteries, with a sensitivity of 93%, a specificity of 71% and an accuracy of 79%. In the cavernosal arteries, DSA depicted 14 normal and 28 impaired arteries; CTA showed seven normal arteries and 35 occlusions. The CTA image agreed closely with the diagnosis of stenosis or occlusion in cavernosal arteries, with a sensitivity of 96%, a specificity of 43% and an accuracy of 79%. Of the 42 inferior epigastric arteries, DSA could not depict 11 arteries but CTA showed all 42 inferior epigastric arteries. CONCLUSIONS CTA images correlated with DSA images; at present DSA is better than CTA in visualizing stenosis in fine arteries. However, CTA is less invasive and relatively inexpensive, and in future will probably provide even greater improvements in graphic quality. CTA would be an adequate replacement for DSA in evaluating internal pudendal arterial stenosis.
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Affiliation(s)
- Y Kawanishi
- Department of Urology, Takamatsu Red Cross Hospital, Kagawa, Japan.
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Abstract
Imaging is an essential component of endoluminal aneurysm repair. Detailed imaging with computed tomography, magnetic resonance imaging and angiography, alone or in combination, is required for the initial assessment and planning. Careful, lifelong follow-up is essential since complications of endoluminal repair may take months or years to appear. Follow-up imaging requires a combination of plain film radiography, colour Doppler ultrasound and helical computed tomography. Magnetic resonance imaging may be valuable for the follow-up of non ferro-magnetic endografts and intra-arterial angiography will be required for specific cases.
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Affiliation(s)
- S C Whitaker
- Department of Clinical Radiology, University Hospital, NG7 2UH, Nottingham, UK.
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