Department of Vascular Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Division of Cardiovascular and Pulmonary Diseases, Department of Vascular Surgery, Section of Vascular Investigations, Oslo University Hospital, Oslo, Norway.
J Vasc Surg. 2020 Dec;72(6):1952-1959. doi: 10.1016/j.jvs.2020.02.020. Epub 2020 Apr 2.
Repeated computed tomography angiography (CTA) can be used during follow-up visits for endovascular aneurysm repair (EVAR) but leads to accumulated radiation exposure and may cause renal impairment. Therefore, the use of contrast-enhanced ultrasound (CEUS) has increased, and its ability to detect endoleaks has been promising. The aim of this study was to investigate the diagnostic accuracy of CEUS vs CTA for endoleak detection during EVAR follow-up.
Ninety-two patients with planned EVAR for abdominal aortic aneurysm were prospectively, consecutively enrolled. In total, 233 paired CTA and CEUS procedures were performed within the same day. Follow-up visits occurred 1 month, 6 months, 12 months, and 24 months postoperatively.
Of 48 endoleaks discovered by CTA, 39 were also detected on CEUS, giving an overall sensitivity of 81.3% and specificity of 98.9%. All undetected endoleaks were minor, without clinical importance, and occurred in patients with high body mass index.
In this study, CEUS was accurate for detecting type II endoleaks during follow-up visits for EVAR. Sensitivity was lower in obese patients. Doppler ultrasound has low sensitivity and seems to be unsuitable for the detection of endoleaks.
在血管内动脉瘤修复术（EVAR）的随访中，可以重复进行计算机断层血管造影（CTA），但这会导致累积的辐射暴露，并可能导致肾功能损害。因此，对比增强超声（CEUS）的使用增加了，其检测内漏的能力也很有前景。本研究旨在探讨 CEUS 与 CTA 在 EVAR 随访中检测内漏的诊断准确性。
前瞻性连续纳入 92 例计划进行腹主动脉瘤 EVAR 的患者。总共在同一天内进行了 233 次 CTA 和 CEUS 配对检查。术后随访 1 个月、6 个月、12 个月和 24 个月。
在 CTA 发现的 48 个内漏中，CEUS 检测到 39 个，总体灵敏度为 81.3%，特异性为 98.9%。所有未检测到的内漏均为次要的，无临床意义，发生在肥胖患者中。
在这项研究中，CEUS 对 EVAR 随访期间检测 II 型内漏是准确的。肥胖患者的敏感性较低。多普勒超声的敏感性较低，似乎不适合检测内漏。
