Non-contrast MR imaging for detecting endoleak after abdominal endovascular aortic repair

Abstract

Our aim was to investigate the possibility of ruling out endoleak after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) using non-contrast MRI. Twenty-three patients (20 males, aged 73 ± 8 years) with an EVAR-treated AAA underwent 1.5-T MRI using axial, coronal and sagittal oblique true-FISP sequences. Two blinded and independent readers with 4 (R1) and 2 (R2) years of experience evaluated these images considering an area of even less than 5 mm in diameter with a signal intensity higher than that of normal muscles visible in the excluded aneurysmal sac as a sign of potential endoleak. The final assessment, mainly based on MR angiography and previous examinations, served as reference standard. Out of 23 patients, 13 (57%) were negative for endoleak at final assessment, while the remaining 10 (43%) were positive, with the following type distribution: Ia (n = 4), Ib (n = 2), II (n = 3), and III (n = 1). Sensitivity was 10/10 (100%; CI 95% 69-100%), specificity 7/13 (54%; 25-81%), accuracy 17/23 (74%; 52-90%), PPV 10/16 (63%; 35-85%) and NPV 7/7 (100%; 59-100%) for R1; 9/10 (90%; 56-100%), 8/13 (62%; 32-86%), 17/23 (74%; 52-90%), 9/14 (64%; 35-8%), and 8/9 (89%; 52-100%) for R2, respectively. Inter-reader Cohen κ was 0.810. A negative non-contrast true-FISP MR study can be used to rule out endoleak after EVAR of AAA. This hypothesis may contribute to the reduction of ionizing radiation exposure and contrast material administration for monitoring patients with an EVAR-treated AAA.