Magnetic Resonance Imaging with a Weak Albumin Binding Contrast Agent can Reveal Additional Endo leaks in Patients with an Enlarging Aneurysm after EVAR

Abstract

WHAT THIS PAPER ADDS In patients with enlarging aneurysms of unknown origin after endovascular aneurysm repair, magnetic resonance imaging (MRI) with a weak albumin binding contrast agent has additional diagnostic value for both the detection and determination of the origin of the endoleak. Therefore, MRI should be considered in patients with aneurysm growth of unknown origin in cases where computed tomography angiography imaging does not reveal a clear cause. Objectives/Background: To examine the additional diagnostic value of magnetic resonance imaging (MRI) after administration of a weak albumin binding contrast agent in post-endovascular aneurysm repair (EVAR) patients with aneurysm growth with no or uncertain endoleak after computed tomography angiography (CTA). Methods: This was a prospective diagnostic cross sectional study carried out between April 2011 and August 2013. MRI was performed in all patients with aneurysm growth >= 5 mm after EVAR implantation and no or uncertain endoleak on CTA, or the inability, on CTA, to identify the source of a visible endoleak. All MRI scans were performed on a 1.5 T clinical MRI scanner after administration of a weak albumin binding contrast agent. The presence of endoleaks was assessed by visually comparing pre- and post-contrast T1-weighted images with fat suppression. Post-contrast images were acquired 5 and 15 minutes after contrast administration. Results: Twenty-nine patients (26 men; 90%) with a median age of 74 years (interquartile range [IQR] 67-76) were included. The median interval between EVAR and MRI was 39 months (IQR 20-50). The median increase in maximum aneurysm diameter during total follow up after EVAR was 11 mm (IQR 6-17). At CTA, 16 patients (55%) had no detectable endoleak, five patients (17%) had suspected but uncertain endoleak, and eight patients had a definite endoleak (28%). On the post-contrast MRI images, endoleak was observed in 24 patients (83%). In all patients with uncertain endoleak on CIA, endoleak was detected with MRI. For type II endoleaks, feeding vessels were detected in 22/23 patients (96%) and these were all, except one, lumbar arteries. Conclusion: In patients with enlarging aneurysms of unknown origin after EVAR, MRI with a weak albumin binding contrast agent has additional value for both the detection and determination of the origin of the endoleak. (C) 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.