Clinical significance of dynamic volume CT angiography in the evaluation of endoleakage after endovascular aortic aneurysm repair

Wang Jingru; Zhang Longxiang; Wang Xue; Cui Yan

doi:10.3969/j.issn.1674-4055.2025.08.10

Abstract：Objective To investigate the feasibility of dynamic volumetric computed tomography(CT)angiography(DV-CTA)in quantitatively detecting endoleakage after endovascular aortic aneurysm repair(EVAR).Methods A retrospective analysis was performed on 22 patients who underwent both the standard three-phase abdominal aortic computed tomography angiography(CTA)protocol and additional DV-CTA after EVAR between January 2021 and June 2022.DV-CTA images were acquired to reconstruct color-coded maps depicting blood perfusion and aneurysm sacs.DV-CTA images were evaluated using a CT perfusion imaging workstation,with DV-CTA leakage index=blood flowleakage/blood flowarterial sac.The dynamic CT perfusion(dCTP)endoleakage index=HUleakage/HUarterial sac.Results All 22 patients completed their first three-phase CTA at the 6th week postoperatively.A total of 12 internal leaks were identified in 8 patients(36.36%).After DV-CTA and dCTP scans,12 and 14 endoleaks were detected,respectively,all of which were typeⅡendoleaks.DV-CTA and dCTP showed good consistency in endoleak detection(κ=0.879,P＜0.001).The dCTP endoleak index was higher than that of DV-CTA,but the time required for reconstruction and analysis of dCTP images was longer than that of DV-CTA(P＜0.001).The median diagnostic confidence scores provided by DV-CTA and dCTP for patients without endoleaks were 1.40±0.49 and 1.04±0.20,respectively.Compared with DV-CTA,dCTP showed higher confidence in excluding endoleaks and overall better diagnostic confidence(P＜0.05).Additionally,the total radiation dose and effective radiation dose of DV-CTA were higher than those of the three-phase CTA(P＜0.05).Conclusion Compared with traditional three-phase CTA,DV-CTA is more beneficial for detecting endoleaks and identifying their types.