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INTRODUCTION: This study evaluated our experience with dynamic computed tomography angiography (dCTA) as a diagnostic tool after endovascular aortic aneurysm repair (EVAR) with respect to the endoleak classification and the available literature. METHODS: We reviewed all patients who underwent dCTA because of suspected endoleaks after the EVAR and classified the endoleaks in these patients based on standard CTA (sCTA) and dCTA. We systematically reviewed all available publications that investigated the diagnostic accuracy of dCTA compared with other imaging techniques. RESULTS: In our single-center series, 16 dCTAs were performed in 16 patients. In 11 patients, the undefined endoleaks that appeared on sCTA scans were successfully classified using dCTA. In three patients with a type II endoleak and aneurysm sac growth, inflow arteries were successfully identified using dCTA, and in two patients, aneurysm sac growth was observed without a visible endoleak on both sCTA and dCTA scans. The dCTA revealed four occult endoleaks, all of which were type II endoleaks. The systematic review identified six series comparing dCTA with other imaging methods. All articles reported an excellent outcome regarding the endoleak classification. In published dCTA protocols, the number and timing of phases varied greatly, affecting radiation exposure. Time attenuation curves of the current series show that some phases do not contribute to the endoleak classification and that the use of a test bolus improves the timing of the dCTA. CONCLUSIONS: The dCTA is a valuable additional tool that can identify and classify endoleaks more accurately than the sCTA. Published dCTA protocols vary greatly and should be optimized to decrease radiation exposure as long as accuracy can be maintained. The use of a test bolus to improve the timing of the dCTA is recommended, but the optimal number of scanning phases is yet to be determined.
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PURPOSE: Patellar tendon shortening may occur following patellofemoral joint replacement (PFJR). We hypothesized that patellar tendon shortening results in unfavourable patient-reported outcomes (PROs). The aim of this study was to determine the effect of patellar tendon shortening following PFJR on PROs. METHODS: In this substudy of a prospective cohort study, a total of 108 patients with isolated patellofemoral osteoarthritis underwent 124 patellofemoral joint replacements. We measured both patellar tendon length and length of the patella on pre-operative radiographs, and on radiographs acquired at eight weeks and at one year post-operative. More than 10% decrease in patellar tendon length relative to the pre-operative patellar tendon length was defined as patellar tendon shortening. Clinical outcomes were assessed using the knee-specific KOOS questionnaire (Knee Injury and Osteoarthritis Outcome Score). Repeated measures ANOVA was used to analyze for differences in change from baseline KOOS subscales between patients with and patients without patellar tendon shortening. RESULTS: A complete series of standardized pre-operative, eight weeks and one year post-operative radiographs was available for 87 knees in 82 patients. At eight weeks, 16 of 87 knees (18%) showed patellar tendon length shortening, and 27 of 87 knees (31%) at one year. We found no statistically significant relation between patellar tendon length shortening and change from baseline KOOS subscales at one year follow-up (pain p = 0.29, symptoms p = 0.56, ADL p = 0.23, sport or recreation p = 0.22, knee-related quality of life (QOL) p = 0.15). CONCLUSIONS: Patellar tendon length shortening following PFJR occurs in 31% of knees at one year, and does not result in inferior PROs.
