Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair: Detection with Dual-Energy Dual-Source CT

posted by Hatem Alkadhi, M.D., M.P.H., E.B.C.R. | Apr 30, 2009


To assess the diagnostic performance of dual-energy dual-source computed tomography (CT) in the detection of endoleaks after endovascular abdominal aortic aneurysm (AAA) repair.

Materials and Methods:

This study was local ethics board approved, and written informed consent was obtained from all patients. One hundred eighteen patients (21 women, 97 men; mean age, 74 years ± 8 [standard deviation]) underwent follow-up dual-energy dual-source CT during the nonenhanced, arterial, and delayed phases after AAA repair. Delayed phase CT images were acquired in the dual-energy mode for reconstruction of virtual nonenhanced images.

Two blinded and independent readers evaluated the data for the presence or absence of endoleaks during three reading sessions: Standard nonenhanced, arterial phase, and delayed phase images were read during session A; virtual nonenhanced, arterial phase, and delayed phase images, during session B; and virtual nonenhanced and delayed phase images, during session C.

Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated, with the session A image data set as the reference standard. Radiation dose parameters were estimated.


Reading session A revealed that 52 (44%) of 118 patients had endoleaks. Overall sensitivity, specificity, NPV, and PPV for CT endoleak detection during sessions B and C were identical: 100%, 97%, 100%, and 96%, respectively.
The accuracy of the session B and session C readings was not significantly different from that of the session A reading (P = .50). The effective radiation dose in the image acquisition protocol involving one dual-energy scan was significantly (P < .001) lower than the effective doses in the protocols involving standard triple-phase scanning (mean difference, 61%) and standard nonenhanced and delayed phase scanning (mean difference, 41%).


Compared with standard protocols, one dual-energy dual source CT scan performed during the delayed phase with reconstruction of virtual nonenhanced images enables detection of endoleaks after endovascular AAA repair with high accuracy and a considerably lower radiation dose.

Full text: Radiology. 2008 Nov;249(2):682-91.

Authors: Paul Stolzmann, Thomas Frauenfelder, Thomas Pfammatter, Nicole Peter, Hans Scheffel, Mario Lachat, Bernhard Schmidt, Borut Marincek, Hatem Alkadhi,MDThomas Schertler,MD

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