Volumetric quantification of type II endoleaks: An indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair

Shadpour Demehri, Jason Signorelli, Kanako K. Kumamaru, Nicole Wake, Elizabeth George, Michael Hanley, Michael L. Steinger, Edwin Charles Gravereaux, Frank J. Rybicki

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Purpose: To test the hypothesis that type II endoleak cavity volume (ECV) and endoleak cavity diameter (ECD) measurements are accurate indicators of aneurysm sac volume (ASV) enlargement in patients who undergo endovascular aneurysm repair (EVAR) in the abdominal aorta. Materials and Methods: The institutional review board approved and waived the need to obtain patient consent for this HIPAA-compliant retrospective study. In 72 patients who underwent EVAR, 160 computed tomographic (CT) angiography studies revealed type II endoleaks. Corresponding to these 160 CT angiography studies, 113 CT follow-up studies (in 52 patients) were available and were included in the analysis. ECV measurements were obtained by two observers in consensus by using arterial enhanced phase (ECVAEP) and 70-second delayed enhanced phase (ECVDEP) CT images. The ECVDEP was also normalized as the ECV/ASV ratio. Maximum (ECDM) and transverse (ECDT) ECDs were determined from delayed enhanced phase images. The outcome was determined as interval increase (>2%) in ASV versus stable or decreasing (≤2%) ASV. Receiver operating characteristic (ROC) analysis was used to compare the accuracy of type II ECV and ECD measurements in indicating interval increase in ASV. Results: In 56 (49.5%) of 113 CT studies in type II endoleaks, there was an interval increase in ASV. The accuracies of ECVDEP (area under the ROC curve [AUC], 0.85) and normalized ECVDEP (AUC, 0.86) were superior to the accuracies of ECDM (AUC, 0.73), ECDT (AUC, 0.73), and ECVAEP (AUC, 0.66). At ROC curve analysis, the sensitivity, specificity, and positive and negative predictive values for type II endoleak cavities with an ECVDEP of less than 0.5 mL for showing no future sac volume enlargement were 33% (19 of 57), 100% (56 of 56), 100% (19 of 19), and 60% (56 of 94), respectively. Conclusion: With use of the delayed enhanced phase of CT angiography, ECV measurement is an accurate indicator of aneurysm sac enlargement.

Original languageEnglish (US)
Pages (from-to)282-290
Number of pages9
JournalRADIOLOGY
Volume271
Issue number1
DOIs
StatePublished - Apr 2014
Externally publishedYes

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Endoleak
Abdominal Aortic Aneurysm
Aneurysm
ROC Curve
Growth
Area Under Curve
Angiography
Health Insurance Portability and Accountability Act
Research Ethics Committees
Abdominal Aorta
Retrospective Studies

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Volumetric quantification of type II endoleaks : An indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair. / Demehri, Shadpour; Signorelli, Jason; Kumamaru, Kanako K.; Wake, Nicole; George, Elizabeth; Hanley, Michael; Steinger, Michael L.; Gravereaux, Edwin Charles; Rybicki, Frank J.

In: RADIOLOGY, Vol. 271, No. 1, 04.2014, p. 282-290.

Research output: Contribution to journalArticle

Demehri, S, Signorelli, J, Kumamaru, KK, Wake, N, George, E, Hanley, M, Steinger, ML, Gravereaux, EC & Rybicki, FJ 2014, 'Volumetric quantification of type II endoleaks: An indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair', RADIOLOGY, vol. 271, no. 1, pp. 282-290. https://doi.org/10.1148/radiol.13130157
Demehri, Shadpour ; Signorelli, Jason ; Kumamaru, Kanako K. ; Wake, Nicole ; George, Elizabeth ; Hanley, Michael ; Steinger, Michael L. ; Gravereaux, Edwin Charles ; Rybicki, Frank J. / Volumetric quantification of type II endoleaks : An indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair. In: RADIOLOGY. 2014 ; Vol. 271, No. 1. pp. 282-290.
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abstract = "Purpose: To test the hypothesis that type II endoleak cavity volume (ECV) and endoleak cavity diameter (ECD) measurements are accurate indicators of aneurysm sac volume (ASV) enlargement in patients who undergo endovascular aneurysm repair (EVAR) in the abdominal aorta. Materials and Methods: The institutional review board approved and waived the need to obtain patient consent for this HIPAA-compliant retrospective study. In 72 patients who underwent EVAR, 160 computed tomographic (CT) angiography studies revealed type II endoleaks. Corresponding to these 160 CT angiography studies, 113 CT follow-up studies (in 52 patients) were available and were included in the analysis. ECV measurements were obtained by two observers in consensus by using arterial enhanced phase (ECVAEP) and 70-second delayed enhanced phase (ECVDEP) CT images. The ECVDEP was also normalized as the ECV/ASV ratio. Maximum (ECDM) and transverse (ECDT) ECDs were determined from delayed enhanced phase images. The outcome was determined as interval increase (>2{\%}) in ASV versus stable or decreasing (≤2{\%}) ASV. Receiver operating characteristic (ROC) analysis was used to compare the accuracy of type II ECV and ECD measurements in indicating interval increase in ASV. Results: In 56 (49.5{\%}) of 113 CT studies in type II endoleaks, there was an interval increase in ASV. The accuracies of ECVDEP (area under the ROC curve [AUC], 0.85) and normalized ECVDEP (AUC, 0.86) were superior to the accuracies of ECDM (AUC, 0.73), ECDT (AUC, 0.73), and ECVAEP (AUC, 0.66). At ROC curve analysis, the sensitivity, specificity, and positive and negative predictive values for type II endoleak cavities with an ECVDEP of less than 0.5 mL for showing no future sac volume enlargement were 33{\%} (19 of 57), 100{\%} (56 of 56), 100{\%} (19 of 19), and 60{\%} (56 of 94), respectively. Conclusion: With use of the delayed enhanced phase of CT angiography, ECV measurement is an accurate indicator of aneurysm sac enlargement.",
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T1 - Volumetric quantification of type II endoleaks

T2 - An indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair

AU - Demehri, Shadpour

AU - Signorelli, Jason

AU - Kumamaru, Kanako K.

AU - Wake, Nicole

AU - George, Elizabeth

AU - Hanley, Michael

AU - Steinger, Michael L.

AU - Gravereaux, Edwin Charles

AU - Rybicki, Frank J.

PY - 2014/4

Y1 - 2014/4

N2 - Purpose: To test the hypothesis that type II endoleak cavity volume (ECV) and endoleak cavity diameter (ECD) measurements are accurate indicators of aneurysm sac volume (ASV) enlargement in patients who undergo endovascular aneurysm repair (EVAR) in the abdominal aorta. Materials and Methods: The institutional review board approved and waived the need to obtain patient consent for this HIPAA-compliant retrospective study. In 72 patients who underwent EVAR, 160 computed tomographic (CT) angiography studies revealed type II endoleaks. Corresponding to these 160 CT angiography studies, 113 CT follow-up studies (in 52 patients) were available and were included in the analysis. ECV measurements were obtained by two observers in consensus by using arterial enhanced phase (ECVAEP) and 70-second delayed enhanced phase (ECVDEP) CT images. The ECVDEP was also normalized as the ECV/ASV ratio. Maximum (ECDM) and transverse (ECDT) ECDs were determined from delayed enhanced phase images. The outcome was determined as interval increase (>2%) in ASV versus stable or decreasing (≤2%) ASV. Receiver operating characteristic (ROC) analysis was used to compare the accuracy of type II ECV and ECD measurements in indicating interval increase in ASV. Results: In 56 (49.5%) of 113 CT studies in type II endoleaks, there was an interval increase in ASV. The accuracies of ECVDEP (area under the ROC curve [AUC], 0.85) and normalized ECVDEP (AUC, 0.86) were superior to the accuracies of ECDM (AUC, 0.73), ECDT (AUC, 0.73), and ECVAEP (AUC, 0.66). At ROC curve analysis, the sensitivity, specificity, and positive and negative predictive values for type II endoleak cavities with an ECVDEP of less than 0.5 mL for showing no future sac volume enlargement were 33% (19 of 57), 100% (56 of 56), 100% (19 of 19), and 60% (56 of 94), respectively. Conclusion: With use of the delayed enhanced phase of CT angiography, ECV measurement is an accurate indicator of aneurysm sac enlargement.

AB - Purpose: To test the hypothesis that type II endoleak cavity volume (ECV) and endoleak cavity diameter (ECD) measurements are accurate indicators of aneurysm sac volume (ASV) enlargement in patients who undergo endovascular aneurysm repair (EVAR) in the abdominal aorta. Materials and Methods: The institutional review board approved and waived the need to obtain patient consent for this HIPAA-compliant retrospective study. In 72 patients who underwent EVAR, 160 computed tomographic (CT) angiography studies revealed type II endoleaks. Corresponding to these 160 CT angiography studies, 113 CT follow-up studies (in 52 patients) were available and were included in the analysis. ECV measurements were obtained by two observers in consensus by using arterial enhanced phase (ECVAEP) and 70-second delayed enhanced phase (ECVDEP) CT images. The ECVDEP was also normalized as the ECV/ASV ratio. Maximum (ECDM) and transverse (ECDT) ECDs were determined from delayed enhanced phase images. The outcome was determined as interval increase (>2%) in ASV versus stable or decreasing (≤2%) ASV. Receiver operating characteristic (ROC) analysis was used to compare the accuracy of type II ECV and ECD measurements in indicating interval increase in ASV. Results: In 56 (49.5%) of 113 CT studies in type II endoleaks, there was an interval increase in ASV. The accuracies of ECVDEP (area under the ROC curve [AUC], 0.85) and normalized ECVDEP (AUC, 0.86) were superior to the accuracies of ECDM (AUC, 0.73), ECDT (AUC, 0.73), and ECVAEP (AUC, 0.66). At ROC curve analysis, the sensitivity, specificity, and positive and negative predictive values for type II endoleak cavities with an ECVDEP of less than 0.5 mL for showing no future sac volume enlargement were 33% (19 of 57), 100% (56 of 56), 100% (19 of 19), and 60% (56 of 94), respectively. Conclusion: With use of the delayed enhanced phase of CT angiography, ECV measurement is an accurate indicator of aneurysm sac enlargement.

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