Department of Vascular Surgery, Ludwig-Maximilians-University Hospital, Munich, Germany.
Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece.
J Vasc Surg. 2019 Jan;69(1):280-294.e6. doi: 10.1016/j.jvs.2018.07.044. Epub 2018 Oct 29.
The purpose of this systematic review and meta-analysis was to investigate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) for detection of endoleak after endovascular aneurysm repair (EVAR).
We searched electronic bibliographic databases for original articles comparing concurrent CEUS and computed tomography angiography for detection of endoleak after EVAR. We assessed the methodologic quality of the studies with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We constructed 2 × 2 contingency tables for all selected studies including true-positive, false-positive, false-negative, and true-negative results for all endoleaks and for type I and type III endoleaks. We used a mixed-effects logistic regression model to estimate summary sensitivity and specificity. We developed hierarchical summary receiver operating characteristic curves and calculated the area under the curve (AUC).
We identified 26 studies reporting a total of 2638 paired scans in 2217 patients. The major risk of bias of the selected studies pertained to blinding for the index test and the reference standard. The pooled sensitivity and specificity of CEUS for all endoleaks were 0.94 (95% confidence interval [CI], 0.89-0.97) and 0.93 (95% CI, 0.89-0.96), respectively. The AUC was 0.98 (95% CI, 0.93-0.99). The summary estimate of sensitivity and specificity for type I and type III endoleaks was 0.97 (95% CI, 0.8-1.00) and 1.00 (95% CI, 0.99-1.00), respectively. The AUC was 1.00 (95% CI, 0.99-1.00).
CEUS has a high sensitivity and specificity in the detection of endoleaks after EVAR. CEUS is a useful tool in EVAR surveillance.
本系统评价和荟萃分析旨在研究对比增强超声（CEUS）检测血管内修复（EVAR）后内漏的诊断准确性。
我们搜索电子文献数据库，以比较 EVAR 后同时进行 CEUS 和计算机断层血管造影（CTA）检测内漏的原始文章。我们使用诊断准确性研究质量评估工具（Quality Assessment of Diagnostic Accuracy Studies-2）评估研究的方法学质量。我们为所有选定的研究构建了 2×2 四格表，包括所有内漏以及 I 型和 III 型内漏的真阳性、假阳性、假阴性和真阴性结果。我们使用混合效应逻辑回归模型估计汇总敏感性和特异性。我们开发了分层汇总受试者工作特征曲线并计算曲线下面积（AUC）。
我们确定了 26 项研究，共报告了 2217 名患者的 2638 对配对扫描。选定研究的主要偏倚风险涉及对指数试验和参考标准的盲法。CEUS 对所有内漏的总体敏感性和特异性分别为 0.94（95%置信区间[CI]，0.89-0.97）和 0.93（95% CI，0.89-0.96）。AUC 为 0.98（95% CI，0.93-0.99）。I 型和 III 型内漏的汇总敏感性和特异性估计值分别为 0.97（95% CI，0.80-1.00）和 1.00（95% CI，0.99-1.00）。AUC 为 1.00（95% CI，0.99-1.00）。
CEUS 在 EVAR 后检测内漏具有较高的敏感性和特异性。CEUS 是 EVAR 监测的有用工具。
