Wen Cynthia Xin, Thanigaimani Shivshankar, Brennan Sonja, Moxon Joseph, Golledge Jonathan
Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, QLD, Australia.
Eur Radiol. 2025 Jun 7. doi: 10.1007/s00330-025-11717-8.
Patients who have undergone endovascular repair of an abdominal or thoracic aortic aneurysm (EVAR or TEVAR) are recommended to undergo lifelong imaging surveillance to detect endoleaks. Gold standard imaging is by triphasic single energy computed tomography (SECT), however, dual-energy CT (DECT) can reduce radiation exposure by reducing the number of scan phases required. The accuracy of DECT in detecting endoleaks is uncertain. This review assessed the diagnostic accuracy of DECT for detecting endoleaks and compared radiation exposure to conventional triphasic SECT.
Observational studies from Scopus and PubMed databases were screened up to 12th June 2024. Ten studies reporting the diagnostic accuracy of patients previously treated by EVAR or TEVAR were included. According to the quality assessment tool for diagnostic accuracy studies (QUADAS-2), all included studies were considered to have a high risk of bias. A meta-analysis of these studies involving 803 scans on 744 patients found that the pooled sensitivity, specificity and diagnostic odds ratio (DOR) of the DECT as compared to the triphasic SECT were 94.0% (95% CI: 88.9%, 96.9%), 98.9% (95% CI: 95.7%, 99.7%), and 266.4 (95% CI: 140.9, 503.8), respectively. A radiation dose reduction by 29-62% was achieved with DECT as compared to the triphasic SECT.
This meta-analysis suggests that DECT has similar diagnostic accuracy to triphasic SECT for diagnosing endoleak after endovascular aneurysm repair. This suggests that DECT could be adopted in clinical practice because of the lower radiation dose as compared to the conventional triphasic SECT.
Question What is the accuracy of dual energy (DE) as compared to triphasic single energy (SE) computed tomography (CT) for diagnosing endoleak after endovascular aneurysm repair? Findings As compared to triphasic SECT, DECT was accurate in diagnosing endoleak after endovascular aneurysm repair and exposed patients to a lower radiation dose. Clinical relevance The radiation dose associated with lifelong follow-up CT scans after endovascular aneurysm repair has been linked to an increased risk of cancer. This study suggests that the use of DECT can reduce radiation exposure without compromising the accuracy of diagnosing endoleak.
对于接受过腹主动脉瘤或胸主动脉瘤血管内修复术（EVAR或TEVAR）的患者，建议进行终身影像学监测以检测内漏。金标准影像学检查是三相单能计算机断层扫描（SECT），然而，双能CT（DECT）可以通过减少所需的扫描相数来降低辐射暴露。DECT检测内漏的准确性尚不确定。本综述评估了DECT检测内漏的诊断准确性，并将辐射暴露与传统的三相SECT进行了比较。
对Scopus和PubMed数据库截至2024年6月12日的观察性研究进行筛选。纳入了10项报告先前接受EVAR或TEVAR治疗患者诊断准确性的研究。根据诊断准确性研究的质量评估工具（QUADAS-2），所有纳入研究均被认为存在高偏倚风险。对这些涉及744例患者的803次扫描的研究进行荟萃分析发现，与三相SECT相比，DECT的合并敏感性、特异性和诊断比值比（DOR）分别为94.0%（95%CI：88.9%，96.9%）、98.9%（95%CI：95.7%，99.7%）和266.4（95%CI：140.9，503.8）。与三相SECT相比，DECT可使辐射剂量降低29%-62%。
这项荟萃分析表明，在诊断血管内动脉瘤修复术后的内漏方面，DECT与三相SECT具有相似的诊断准确性。这表明，由于与传统的三相SECT相比辐射剂量较低，DECT可应用于临床实践。
问题与三相单能计算机断层扫描（CT）相比，双能（DE）CT诊断血管内动脉瘤修复术后内漏的准确性如何？研究结果与三相SECT相比，DECT在诊断血管内动脉瘤修复术后内漏方面准确，且使患者接受的辐射剂量更低。临床意义血管内动脉瘤修复术后终身随访CT扫描的辐射剂量与癌症风险增加有关。本研究表明，使用DECT可降低辐射暴露，同时不影响诊断内漏的准确性。
