In April of 1955 a famous scientist presented to his physician with severe upper abdominal pain. Known to be a pipe smoker and a bit overweight this patient had suffered from these painful attacks for several years prior.... Considered to be the most influential person of the 20th century, Albert Einstein's death was caused by a massive abdominal aortic aneurysm.

Studies presented at the 108th ARRS meeting in Washington DC show that things have changed since April of 1955.

In the United States alone, abdominal aortic aneurysms are the cause of over 15,000 deaths a year, states Dr. Aravind Arepally, Assistant Professor of Radiology and Surgery at the Johns Hopkins University School of Medicine.

Until a few years ago, the treatment of choice for an abdominal aortic aneurysm would have been open surgical resection. However, endovascular repair of abdominal aortic aneurysms (EVAR) has recently become a preferred and valuable alternative for many patients.

Endovascular repair has been shown to be less stressful for the patient and reduce hospital stay, as well as reduce instances of procedure complications, morbidity and mortality. "Data supports endovascular repair," says Arepally. On the other hand, he adds, "endoleak development post EVAR is the biggest problem we face."

In a 67 patient study, Dr. Dirk Clevert of the Department of Radiology, University of Munich-Grosshadern campus, compared the effectiveness of CT-angiography (CTA) and contrast-enhanced ultrasound (CE-US) in identification and classification of endoleaks after endovascular repair of abdominal aortic aneurysm.

The patients were examined by both CE-US and CTA. Clevert notes, "In conflicting cases, digital subtraction angiography (DSA) or follow up was performed."

Researchers concluded CE-US allowed better visualization and classification of type II and III endoleaks than CTA. Furthermore, "CE-US imaging technique was also able to depict in real time imaging precise detail," says Clevert.

"CTA run-off, a fast exam, easy to perform but..., is it ideal for every patient?" asks Dr. Bernhard Meyer, Department of Radiology and Nuclear medicine, Charité-University Hospital, Campus Benjamin Franklin, Berlin Germany.

Using digital subtraction angiography (DSA) as the gold standard, Dr. Meyer et al assessed the influence of degree of arterial wall calcification and different cardiovascular risk factors on MDCTA of peripheral arteries.

Researchers performed MDCTA on 50 patients. Using a five-point scale to grade stenosis, images were reviewed by two blinded readers (A, B) and the degree of arterial wall calcifications, as well as steno-occlusive lesions, was scored. Cardiovascular risk factors were also recorded at this time.

Results showed that of the 959 lesions on DSA, 26 from the reader (A) and 30 from reader (B) were considered nondiagnostic on MDCTA. Reader (A) reported 100 per cent of nondiagnostic segments had a high degree of calcification while reader (B) reported 97 per cent. It was noted that sensitivity, specificity and agreement between MDCTA and DSA decreased with degree of calcification for both readers.

"CTA should not be used in heavily calcified vessels," suggests Meyer. "In patients with diabetes, findings were located in heavily calcified vessels," he said.

The study concluded that MDCTA had a low overall rate of nondiagnostic segments that occurred almost exclusively in patients with extensive calcification, thus reducing its sensitivity and specificity, particularly in patients with diabetes and terminal renal failure. MDCTA is not recommended in these patients.