Prospective Evaluation of Magnetic Resonance Imaging After Endovascular Treatment of Infrarenal Aortic Aneurysms

Haulon, Stéphan; Lions, Christophe; McFadden, Eugène; Koussa, Mohamad; Gaxotte, Virginia; Halna, Pascal; Beregi, Jean‐Paul

doi:10.1053/ejvs.2001.1405

Cited by 96 publications

(57 citation statements)

References 16 publications

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“…eral modalities are used, including computed tomographic angiography (CTA), magnetic resonance angiography (MRA), or ultrasound examination. [1][2][3][4][5][6][7] CTA is the most widely employed imaging modality but has the drawback of iodinated contrast. Many patients have contrast allergies or renal insufficiency that prevents the use of contrast agents.…”

Section: Fig 1ࡗthementioning

confidence: 99%

Durability and Validity of a Remote, Miniaturized Pressure Sensor in an Animal Model of Abdominal Aortic Aneurysm

Milner¹,

Ruurda²,

Blankensteijn³

2004

Journal of Endovascular Therapy

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ࡗ ࡗPurpose: To investigate whether a remote, miniaturized pressure sensor could maintain calibration and function through organized thrombus over an extended period in a porcine model of abdominal aortic aneurysm (AAA). Methods: Six adult pigs had an AAA surgically created and excluded. A sensor zeroed to atmospheric pressure was placed within the aneurysm sac and another within the suprarenal aorta of each animal. Pressure measurements were taken at the initial operation and then on a weekly basis over 2 months. The aortic sensors were correlated to an intraarterial pressure catheter at the initial operation and at the time of sacrifice. Back-table sensor correlation with atmospheric pressure was done at the time of explantation. Results: Three animals died during the follow-up period. Five animals were available for 6-week follow-up, of which 3 survived for the complete 8-week protocol. Two of the surviving animals had an intra-aortic sensor. All 5 aneurysm sac sensors functioned throughout the experimental period. At the time of sacrifice, the sacs contained a large amount of organized thrombus in which the sac sensors were deeply embedded. The 3 aortic sensors also functioned throughout the course of the experiments. The pressures correlated within 5 mmHg to the catheter-based measurements taken at the initial operation and at the time of sacrifice. Comparison to atmospheric pressure revealed no calibration offset in any sensor.Conclusions: This chronic implantation study demonstrates the durability of a remote, miniaturized pressure sensor within a surgically created aneurysm sac as well as the suprarenal aorta of a porcine AAA model. There was no calibration offset in any of the sensors, and they remained valid at explantation. We believe that this is further evidence of the potential applicability of this sensor for clinical use. The current gold standard for evaluating the status of an excluded abdominal aortic aneurysm (AAA) after endovascular aneurysm repair (EVAR) is interval imaging studies. Sev-

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Section: Fig 1ࡗthementioning

confidence: 99%

Durability and Validity of a Remote, Miniaturized Pressure Sensor in an Animal Model of Abdominal Aortic Aneurysm

Milner¹,

Ruurda²,

Blankensteijn³

2004

Journal of Endovascular Therapy

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“…Although most centers use CTA follow-up for AAA patients, MRI is attracting attention as a modality that may replace CTA in this application. Advantages of MRI over CTA are the lack of ionizing radiation and nephrotoxic contrast agent, increased sensitivity to endoleaks, and improved softtissue contrast which enables assessment of thrombus consistency [1]. Most publications on computerized AAA segmentation describe segmentation of the contrast-filled lumen in CTA images.…”

Section: Introductionmentioning

confidence: 99%

Automated Segmentation of Abdominal Aortic Aneurysms in Multi-spectral MR Images

Bruijne

Ginneken

Bartels

et al. 2003

Lecture Notes in Computer Science

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Abstract. An automated method for segmenting the outer boundary of abdominal aortic aneurysms in MR images is presented. The method is based on the well known Active Shape Models (ASM), which fit a global landmark-based shape model on the basis of local boundary appearance models. The original threedimensional ASM scheme is modified to deal with multi-spectral image information and inconsistent boundary appearance in a principled way, with only a limited amount of training data. In addition, a framework for user interaction is proposed. If required, the obtained segmentation can be corrected in an interactive manner by indicating points on the desired boundary. The methods are evaluated in leave-one-out experiments on 21 datasets. A segmentation scheme combining gray level information from two or three MR sequences produces significantly better results than a single-scan model. Average volume errors with respect to the manual segmentation are 4.0%, in 19 out of 21 datasets. In the cases in which the obtained error is large, results can easily be improved using the interactive scheme.

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“…Typically, triphasic, unenhanced, arterial, and delayed phase CTA is performed for post-EVAR surveillance; however, it often fails to detect the type II endoleaks detected by MRA. 12, 18 In our study, intraoperative completion angiography identified of the pre-and post-EVAR CTA and MRA identified a contrast leakage near the 4th right LA (R4) and the 4th left LA (L4) (Figures 6B-E). The 4D-flow analysis confirmed the connection between the inflow and outflow branches, which is characteristic of a type IIb endoleak ( Figure 6F; Movie S3).…”

Section: Type IV Endoleakmentioning

confidence: 49%

Hemodynamic Analysis of Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair by Using 4-Dimensional Flow-Sensitive Magnetic Resonance Imaging

Sakata

Takehara

Katahashi

et al. 2016

Circ J

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Background: An endoleak is a common complication of endovascular abdominal aortic aneurysm repair (EVAR), and it can be associated with aneurysmal growth. This pilot study used 4-dimensional flow-sensitive magnetic resonance imaging (4D-flow) to assess the hemodynamics of different types of endoleaks (I-IV). Methods and Results:Magnetic resonance angiography, 4D-flow, and computed tomography angiography (CTA) were performed in 31 patients after nitinol-based stent-graft deployment. With 4D-flow, the 3D streamlines of endoleaks appear as integrated traces along the instantaneous velocity vector field that are color-coded according to the local velocity magnitude of the leak. The 4D-flow analysis identified endoleaks in 18 patients (58.1%), whereas CTA identified endoleaks in 13 patients (41.9%). The 4D-flow analysis created a characteristic image of each type of endoleak. Among patients with endoleaks, 4D-flow identified concomitant multiple endoleaks in 7 (39%) patients, and it further differentiated type II endoleaks from type IIa endoleaks (to-and-fro biphasic flow pattern from a branch vessel) and from type IIb endoleaks (monophasic flow pattern with a connection between the inflow and outflow branches). Conclusions:The 4D-flow analysis was more sensitive than CTA for detecting an endoleak, and it could subclassify type II endoleaks. In addition, 4D-flow differentiated between concomitant endoleak types in a single patient. (Circ J 2016; 80: 1715 -1725

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Prospective Evaluation of Magnetic Resonance Imaging After Endovascular Treatment of Infrarenal Aortic Aneurysms

Abstract: MRI after injection of Gadolinium is more sensitive than helical CT in the detection of type II endoleaks after stentgraft implantation. Its more widespread use may permit earlier intervention in such patients.

Cited by 96 publications

References 16 publications

Durability and Validity of a Remote, Miniaturized Pressure Sensor in an Animal Model of Abdominal Aortic Aneurysm

Durability and Validity of a Remote, Miniaturized Pressure Sensor in an Animal Model of Abdominal Aortic Aneurysm

Automated Segmentation of Abdominal Aortic Aneurysms in Multi-spectral MR Images

Hemodynamic Analysis of Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair by Using 4-Dimensional Flow-Sensitive Magnetic Resonance Imaging

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