Contrast Enhancement Boost Technique at Aortic Computed Tomography Angiography: Added Value for the Evaluation of Type II Endoleaks After Endovascular Aortic Aneurysm Repair

Publication date: Available online 30 January 2019

Source: Academic Radiology

Author(s): Hitoshi Iizuka, Yasuhiro Yokota, Masafumi Kidoh, Seitaro Oda, Osamu Ikeda, Yoshitaka Tamura, Yoshinori Funama, Daisuke Sakabe, Takeshi Nakaura, Yasuyuki Yamashita, Daisuke Utsunomiya

Rationale and Objectives

Delayed-phase acquisition of the computed tomography (CT) angiography is important for the evaluation of type II endoleaks after endovascular aortic aneurysm repair because the endoleak cavity area is associated with aneurysm sac expansion. Contrast enhancement boost (CE-boost) is a postprocessing technique for increasing the degree of contrast enhancement on contrast-enhanced CT. We aimed to investigate the usefulness of the CE-boost technique for the visualization of type II endoleaks.

Materials and Methods

This retrospective study included 28 patients with type II endoleaks after endovascular aortic aneurysm repair who underwent triphasic contrast-enhanced CT. Objective (CT number, signal-to-noise ratio, and contrast-to-noise ratio) and subjective quality analyses using a four-point scale (1, poor; 4, excellent) were performed for the conventional early- and delayed-phase images as well as CE-boost delayed-phase images.

Results

The CE-boost delayed-phase images yielded a significantly higher CT number (134.5 ± 41.7 HU), signal-to-noise ratio (23.4 ± 10.5), and contrast-to-noise ratio (15.3 ± 8.4) and showed a significantly larger endoleak area (145.0 ± 134.8 mm²) than did the conventional early-phase (95.6 ± 53.2 HU, 7.3 ± 4.7, 4.0 ± 4.2, and 56.2 ± 99.3 mm², respectively) and delayed-phase (110.5 ± 33.3 HU, 8.2 ± 2.7, 4.9 ± 2.0, and 124.8 ± 131.9 mm², respectively) images (p < 0.01). The endoleak visibility score was highest for the CE-boost delayed-phase images (2.0 ± 1.0, 3.0 ± 0.6, and 3.4 ± 0.7 for conventional early-phase, delayed-phase, and delayed-phase CE-boost images, respectively; p < 0.001).

Conclusion

The CE-boost technique facilitates clear visualization of type II endoleak cavities.

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