Original title: Magnetic Resonance Imaging is More Sensitive than Computed Tomography Angiography for the Detection of Endoleaks after Endovascular Abdominal Aortic Aneurysm Repair: A Systematic Review. Reference: J. Habets et al. European Journal of Vascular and Endovascular Surgery Volume 45 Issue 4 April/2013

Currently computed tomography angiography (CTA) with late stages is considered the most appropriate method to evaluate endoleaks after stent implantation in the abdominal aorta (EVAR), however sometimes the CTA does not have sufficient sensitivity to detect them and this is especially important in patients with aneurysmal sac growth post EVAR. Nuclear magnetic resonance (NMR) has an excellent display of the soft tissue but otherwise may be limited by the artifacts generated by the prosthesis. 

The objective of this meta-analysis was to evaluate the target role of NMR for diagnosing endoleaks post stent implantation compared with tomography (CTA). We analyzed 11 studies with a total of 369 patients who underwent both CTA and NMR with a difference of no more than 30 days of each other. Globally NMR detected 278 endoleaks in this population compared to 146 diagnosed by CTA which corresponds to 132 additional leaks. Furthermore NMR could not show 2 leaks type I that were seen with CTA. Of the 132 additional endoleaks diagnosed by NMR, 86 (69%) were type II, 12 (10%) type III, and 26 (21%) indeterminate.

Conclusion: 

NMR is more sensitive than CTA for detecting leaks after stent implantation in the abdominal aorta, especially type II leaks. Resonance imaging a complementary study to CTA can be considered if the aneurysmal sac growth without a clear cause.

Commentary: 

There was great heterogeneity among the works which is a constraint to draw further conclusions. Two things to keep in mind, first thing; furthermost did not report whether these endoleaks were associated with sac growth and the second is that the stainless steel prosthesis (i.e. Zenith, Cook) are not supported or at least fall into the category of conditional for NMR.

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