Ma C, Zhang J, Xiao M, Kang N, Chen Y H, Dai X C
Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China.
Zhonghua Yi Xue Za Zhi. 2023 Jul 18;103(27):2106-2111. doi: 10.3760/cma.j.cn112137-20230214-00202.
To investigate the value of contrast-enhanced ultrasound in detecting endoleak after endovascular repair of infrarenal abdominal aortic aneurysm (EVAR). The postoperative follow-up data of 102 patients with infrarenal abdominal aortic aneurysm treated with EVAR in Tianjin Medical University General Hospital from August 2015 to December 2021 were retrospectively analyzed. There were 79 males and 23 females, aged 50-91 (69.6±7.6) years old. Using CT angiography (CTA) as the gold standard for diagnosing endoleaks, the effectiveness of contrast-enhanced ultrasound and CDUS in detecting endoleaks was evaluated by paired design chi-square test, and the Kappa value was calculated for consistency test. Patients were divided into groups according to body mass index (BMI), and the number of false-negative endoleaks detected by contrast-enhanced ultrasound in each group was calculated, and its ratio to the actual number of endoleaks was calculated to evaluate whether BMI was related to false-negative ultrasound-enhanced ultrasound. A total of 203 follow-up visits met the inclusion criteria. Endoleaks were detected 36 times (17.7%) by CTA, 31 times (15.3%) by contrast-enhanced ultrasound, 16 times (7.9%) by CDUS, and they all detected type Ⅰ, type Ⅱ and type Ⅲ endoleaks. There was no significant difference between contrast-enhanced ultrasound and CTA in endoleak detection rate and determination of endoleak types (endoleak detection rate: 15.3% vs 17.7%; determination of endoleak types: type Ⅰ 4 vs 4, type Ⅱ 26 vs 31, type Ⅲ 1 vs 1; all >0.05). CDUS and CTA had statistically significant differences in the detection rate of endoleaks and determination of endoleak types (endoleak detection rate: 7.9% vs 17.7%; determination of endoleak types: type Ⅰ 4 vs 4, type Ⅱ 11 vs 31, type Ⅲ 1 vs 1; all <0.001). Compared with CTA, contrast-enhanced ultrasound has a sensitivity of 83.3%, a specificity of 99.4%, a Youden index of 0.827, a coincidence rate of 96.6%, a positive predictive value of 96.8%, a negative predictive value of 96.5%, and a Kappa value of 0.875(<0.001). The two showed excellent diagnostic consistency. All 6 endoleaks not detected by contrast-enhanced ultrasound were type Ⅱ endoleak that did not require treatment, and 3(15.8%) occurred in obese patients with a BMI≥32 kg/m. Compared with CTA, CDUS had a sensitivity of 38.9%, a specificity of 98.8%, a Youden index of 0.377, a coincidence rate of 88.2%, a positive predictive value of 87.5%, a negative predictive value of 88.2%, and a Kappa value of 0.482 (<0.001). The two showed moderate diagnostic agreement. The correlation coefficient of the maximum diameter of aneurysms measured by ultrasound and CT was =0.873(<0.001). Contrast-enhanced ultrasound is accurate in detecting endoleak after infrarenal EVAR, and its sensitivity to endoleak detection in obese patients with BMI≥32 kg/m will be reduced. CDUS is not suitable for detection of endoleak after infrarenal EVAR, but it can be used to monitor the change of the largest diameter of aneurysm after EVAR.
探讨超声造影在检测肾下腹主动脉瘤腔内修复术后内漏中的价值。回顾性分析2015年8月至2021年12月在天津医科大学总医院接受腔内修复术治疗的102例肾下腹主动脉瘤患者的术后随访资料。其中男性79例，女性23例，年龄50 - 91岁（69.6±7.6岁）。以CT血管造影（CTA）作为诊断内漏的金标准，采用配对设计χ²检验评估超声造影和彩色多普勒超声（CDUS）检测内漏的有效性，并计算Kappa值进行一致性检验。根据体重指数（BMI）对患者分组，计算每组超声造影检测到的内漏假阴性数量，并计算其与实际内漏数量的比值，以评估BMI是否与超声造影假阴性有关。共203次随访符合纳入标准。CTA检测到内漏36次（17.7%），超声造影检测到31次（15.3%），CDUS检测到16次（7.9%），三者均检测到Ⅰ型、Ⅱ型和Ⅲ型内漏。超声造影与CTA在内漏检测率及内漏类型判定方面差异无统计学意义（内漏检测率：15.3%对17.7%；内漏类型判定：Ⅰ型4对4，Ⅱ型26对31，Ⅲ型1对1；均>0.05）。CDUS与CTA在内漏检测率及内漏类型判定方面差异有统计学意义（内漏检测率：7.9%对17.7%；内漏类型判定：Ⅰ型4对4，Ⅱ型11对31，Ⅲ型1对1；均<0.001）。与CTA相比，超声造影的灵敏度为83.3%，特异度为99.4%，约登指数为0.827，符合率为96.6%，阳性预测值为96.8%，阴性预测值为96.5%，Kappa值为0.875（<0.001），两者显示出良好的诊断一致性。超声造影未检测到的6例内漏均为Ⅱ型且无需治疗的内漏，其中3例（15.8%）发生在BMI≥32 kg/m²的肥胖患者中。与CTA相比，CDUS的灵敏度为38.9%，特异度为98.8%，约登指数为0.377，符合率为88.2%，阳性预测值为87.5%，阴性预测值为88.2%，Kappa值为0.482（<0.001），两者显示出中度诊断一致性。超声与CT测量动脉瘤最大直径的相关系数r =0.873（<0.001）。超声造影在检测肾下腹主动脉瘤腔内修复术后内漏方面准确，其对BMI≥32 kg/m²肥胖患者内漏检测的灵敏度会降低。CDUS不适合检测肾下腹主动脉瘤腔内修复术后内漏，但可用于监测腔内修复术后动脉瘤最大直径的变化。
