Lowe Christopher, Abbas Abeera, Rogers Steven, Smith Lee, Ghosh Jonathan, McCollum Charles
Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
Independent Vascular Services, University Hospital South Manchester, Manchester, United Kingdom.
J Vasc Surg. 2017 May;65(5):1453-1459. doi: 10.1016/j.jvs.2016.10.082. Epub 2016 Dec 22.
Three-dimensional contrast-enhanced ultrasound (3D-CEUS) is a novel technology allowing surgeons to view duplex ultrasound images in three dimensions with ultrasound contrast highlighting blood flow in endoleaks after endovascular aneurysm repair (EVAR). It potentially reduces the need for computed tomography angiography (CTA) and catheter angiography. This study compares 3D-CEUS with both CTA and the final vascular multidisciplinary team (MDT) diagnosis using all available imaging. Interoperator variability for detection of endoleak and the influence of 3D-CEUS on patient management were studied.
A consecutive 100 patients undergoing CTA for EVAR surveillance were invited to undergo standard CEUS and 3D-CEUS on the same day, with 3D-CEUS reported independently by two blinded vascular scientists. Presence and type of endoleak were compared between CTA, standard CEUS, 3D-CEUS, and the final diagnostic decision made in the vascular MDT meeting. Interoperator reliability of 3D-CEUS was analyzed using the κ statistic.
The 100 paired CTA, CEUS, and 3D-CEUS studies were analyzed. Compared with CTA, the sensitivity, specificity, positive predictive value, and negative predictive value of 3D-CEUS to endoleak were 96%, 91%, 90%, and 96%, respectively. Compared with the MDT decision with access to all imaging modalities, the sensitivity, specificity, positive predictive value, and negative predictive value of 3D-CEUS were 96%, 100%, 100%, and 96%. The κ statistic for interoperator agreement was 0.89.
3D-CEUS was more sensitive and accurate than CTA for endoleak detection and classification after EVAR. 3D-CEUS is now our initial investigation of choice in cases of sac expansion during duplex ultrasound follow-up or if there is diagnostic uncertainty on standard duplex ultrasound or CTA.
三维对比增强超声（3D-CEUS）是一项新技术，可让外科医生以三维方式查看双功超声图像，超声造影可突出血管内动脉瘤修复术（EVAR）后内漏中的血流情况。它有可能减少计算机断层血管造影（CTA）和导管血管造影的需求。本研究将3D-CEUS与CTA以及使用所有可用影像学检查的最终血管多学科团队（MDT）诊断进行比较。研究了内漏检测的操作者间变异性以及3D-CEUS对患者管理的影响。
连续邀请100例接受CTA进行EVAR监测的患者在同一天接受标准CEUS和3D-CEUS检查，由两名不知情的血管科学家独立报告3D-CEUS检查结果。比较CTA、标准CEUS、3D-CEUS以及血管MDT会议做出的最终诊断决定中内漏的存在情况和类型。使用κ统计量分析3D-CEUS的操作者间可靠性。
对100对CTA、CEUS和3D-CEUS研究进行了分析。与CTA相比，3D-CEUS对内漏的敏感性、特异性、阳性预测值和阴性预测值分别为96%、91%、90%和96%。与可获取所有影像学检查方式的MDT决定相比，3D-CEUS的敏感性、特异性、阳性预测值和阴性预测值分别为96%、100%、100%和96%。操作者间一致性的κ统计量为0.89。
在EVAR后内漏检测和分类方面，3D-CEUS比CTA更敏感、准确。在双功超声随访期间出现瘤体扩大的病例中，或者在标准双功超声或CTA存在诊断不确定性时，3D-CEUS现在是我们首选的初步检查方法。
