• D Javor, A Wressnegger, S Unterhumer, K Kollndorfer, R Nolz, D Beitzke, and C Loewe.
• Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Währingergürtel 18-20, A-1090, Vienna, Austria. domagoj.javor@meduniwien.ac.at.
• Eur Radiol. 2017 Apr 1; 27 (4): 1622-1630.

ObjectivesTo assess a single-phase, dual-energy computed tomography (DECT) with a split-bolus technique and reconstruction of virtual non-enhanced images for the detection of endoleaks after endovascular aneurysm repair (EVAR).MethodsFifty patients referred for routine follow-up post-EVAR CT and a history of at least one post-EVAR follow-up CT examination using our standard biphasic (arterial and venous phase) routine protocol (which was used as the reference standard) were included in this prospective trial. An in-patient comparison and an analysis of the split-bolus protocol and the previously used double-phase protocol were performed with regard to differences in diagnostic accuracy, radiation dose, and image quality.ResultsThe analysis showed a significant reduction of radiation dose of up to 42 %, using the single-acquisition split-bolus protocol, while maintaining a comparable diagnostic accuracy (primary endoleak detection rate of 96 %). Image quality between the two protocols was comparable and only slightly inferior for the split-bolus scan (2.5 vs. 2.4).ConclusionsUsing the single-acquisition, split-bolus approach allows for a significant dose reduction while maintaining high image quality, resulting in effective endoleak identification.Key Points• A single-acquisition, split-bolus approach allows for a significant dose reduction. • Endoleak development is the most common complication after endovascular aortic repair (EVAR). • CT angiography is the imaging modality of choice for aortic aneurysm evaluation.

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