An animal model for type II endoleaks with use of a tsuzumi drum-shaped stent-graft.

PURPOSE: To create an animal model of type II endoleaks after endoluminal deployment of a specially designed stent-graft (SG). MATERIALS AND METHODS: Five swine were used. A tsuzumi drum-shaped SG consisting of a covered Z stent with its diameter narrowed at the center was deployed in the midthoracic aorta. In this way, a residual space (RS) was created between the aortic wall and the graft to simulate an aneurysm sac. A 5-F catheter was placed into the RS, and then aortography, RS angiography, and pressure measurements were performed. Follow-up was performed at 3 and 10 days after the procedure. Mean pressure indexes (MPIs) were calculated as the ratio of the mean RS pressure to the aortic pressure. Histologic examination was also performed. RESULTS: RSs with two or three pairs of intercostal arteries were successfully created in all cases. Aortography showed two type II endoleaks in five swine just after SG deployment and four type II endoleaks at 10 days. RS angiography showed circulation between the RS and the intercostal arteries in all cases. The mean MPI was 69.4% +/- 10.4% just after SG deployment and increased to 87.8% +/- 5.2% at 10 days. By gross examination, RS patency was retained. CONCLUSIONS: A swine model of type II endoleaks was successfully created endoluminally. This model does not require direct surgery to the aorta and its side branches and promises to be useful to study the mechanism of and therapy for type II endoleaks.

Detection of portal perfusion abnormalities: comparison of 3 ferucarbotran-enhanced magnetic resonance imaging sequences.

OBJECTIVE: To estimate the accuracy, sensitivity, and specificity of 3 ferucarbotran-enhanced magnetic resonance (MR) imaging sequences prospectively for the detection of nontumoral portal perfusion abnormalities. METHODS: Thirty-nine noncirrhotic patients with liver metastases underwent computed tomography during arterial portography (CTAP) and MR imaging comprising T1-weighted gradient recalled echo (GRE), T2-weighted fast spin echo (FSE), and T2*-weighted GRE sequences with and without ferucarbotran. Magnetic resonance images were reviewed by 4 blinded observers for rating based on the confidence scale. The accuracy, sensitivity, and specificity for each sequence were measured by receiver operating characteristic analysis. Contrast-to-noise ratio (CNR) and relative signal-to-noise ratio changes were statistically compared. RESULTS: Thirty-nine nontumoral perfusion defects were observed in 22 patients by CTAP. Receiver operating characteristic analysis showed the accuracy was higher for T2*-weighted GRE (0.884) than for T1-weighted GRE (0.572) and T2-weighted FSE (0.597). T2*-weighted imaging achieved the highest sensitivity (81.4%) and the lowest specificity (86.6%). Postenhanced T2*-weighted imaging achieved the highest CNR (19.3 +/- 9.2). CONCLUSIONS: T2*-weighted imaging was the most accurate and sensitive method for detecting portal perfusion abnormalities compared with T1- or T2-weighted imaging, whereas T1- or T2-weighted imaging is superior in specificity to T2*-weighted imaging during ferucarbotran-enhanced MR imaging.