Hemodynamic Analysis of Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair by Using 4-Dimensional Flow-Sensitive Magnetic Resonance Imaging
Hemodynamic Analysis of Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair by Using 4-Dimensional Flow-Sensitive Magnetic Resonance Imaging
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DOI：
10.1253/circj.cj-16-0297
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发表时间：
2016-08-01
影响因子：
3.3
通讯作者：
Unno, Naoki
中科院分区：
文献类型：
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作者：
Sakata, Mayu;Takehara, Yasuo;Unno, Naoki
背景资料：内漏是腹主动脉瘤腔内修复术（EVAR）的常见并发症，可能与瘤样生长相关。本初步研究使用4维血流敏感性磁共振成像（4D-flow）评估不同类型内漏（I-IV）的血流动力学。方法和结果：31例患者在镍钛诺支架植入物展开后进行了磁共振血管造影、4D-flow和计算机断层扫描血管造影（CTA）。在4D流的情况下，内漏的3D流线表现为沿着瞬时速度矢量场的积分迹线，其根据泄漏的局部速度大小进行颜色编码。4D血流分析确定了18例患者（58.1%）的内漏，而CTA确定了13例患者（41.9%）的内漏。4D血流分析创建了每种类型内漏的特征图像。在发生内漏的患者中，4D血流在7例（39%）患者中发现了伴随的多发性内漏，并进一步区分了II型内漏和IIa型内漏（来自分支血管的往返双相流模式）和IIb型内漏（流入和流出分支之间连接的单相流模式）。结论：4D血流分析比CTA检测内漏更敏感，并且可以对II型内漏进行细分。此外，4D血流区分了1例患者的合并内漏类型。
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.