Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study
Authors/Creators
- 1. Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy.
- 2. Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, 20122 Milan, Italy.
- 3. Clinical and Community Sciences Department, Università degli Studi di Milano, 20122 Milan, Italy.
- 4. Unit of Vascular Surgery, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy.
- 5. Unit of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milan, Italy.
Description
Secchi F, Capra D, Monti CB, Mobini N, Ortiz MDMG, Trimarchi S, Mazzaccaro D, Righini P, Nano G, Sardanelli F. Safe Follow-Up after Endovascular Aortic Repair with Unenhanced MRI: The SAFEVAR Study. Diagnostics (Basel). 2022 Dec 21;13(1):20. doi: 10.3390/diagnostics13010020. PMID: 36611311; PMCID: PMC9818075.
Abstract
We aimed to investigate whether unenhanced magnetic resonance imaging (MRI) could represent a safe and highly sensitive tool for endoleak screening in patients treated with endovascular aneurysm repair (EVAR) using computed tomography angiography (CTA) as a reference standard. Patients who underwent CTA for EVAR follow-up at our institution were prospectively enrolled. All MRI examinations were performed with a 1.5 T unit. The true-FISP and HASTE sequences of the MRI scans were assessed for the presence of hyperintensity within the aneurysm sac outside the graft, whereas phase-contrast through-plane sequences were used for blood flow quantification. We included 45 patients, 5 (11%) of whom were female. The median age was 73 years (IQR 68-78 years). Among our patients, 19 (42%) were positive for endoleaks at CTA, of whom 13 (68%) had type II endoleaks and 6 (32%) had type I endoleaks. There were no significant differences in age, sex, aneurysm type, prosthesis type, or contrast-to-noise ratio between hyperintensity and thrombus between patients with and without endoleaks (p > 0.300). The combined evaluation of true-FISP and HASTE yielded 100% sensitivity (95% CI: 79-100%) and 19% specificity (95% CI: 7-40%). Patients with a positive CTA had a median thrombus flow of 0.06 L/min (IQR 0.03-0.23 L/min), significantly greater than that of patients with a negative CTA (p = 0.007). Setting a threshold at 0.01 L/min, our MRI protocol yielded 100% sensitivity, 56% specificity, and an AUC of 0.76 (95% CI 0.60-0.91). In conclusion, unenhanced MRI has perfect sensitivity for endoleak detection, although with subpar specificity that could be improved with phase-contrast flow analysis.
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