77 year old woman with Type II endoleak associated with a lumbar artery.
A) Arterial phase CT image demonstrates focal contrast opacification (arrow) within the excluded aneurysm sac, compatible with endoleak.
B) Regions of interest placed on endoleak (labeled “1”) and in thrombosed aneurysm sac (labeled “Background”).
C) Optimal contrast-to-noise ratio (CNR) curve generated with Gemstone Spectral Imaging (GSI) software package (GE Healthcare) using above regions of interest for this specific endoleak, indicating maximum conspicuity at 54 keV (red vertical bar). A second slightly lower peak is noted around 70 keV in this and every patient, corresponding to the general peak of contrast-to-noise for monochromatic reconstructions from fast-switch kVp dual energy data.