Contrast-enhanced ultrasound (CEUS) versus computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients. Are delayed type II endoleaks being missed? A systematic review and meta-analysis

Chung, Jameson; Kordzadeh, Ali; Prionidis, Ioannis; Panayiotopoulos, Y.P.; Browne, Thomas R.

doi:10.1007/s40477-014-0154-x

Cited by 50 publications

(48 citation statements)

References 38 publications

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“…Following the results of our work and the more recent literature [33], CEUS exam results are better than CT to identify endoleaks, since the relatively long time of permanence of the contrast agent (more than 5 min) in the blood flow and real-time study allows the study of patients also in delayed phases.…”

Section: Resultssupporting

confidence: 62%

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

David

Cantisani

Grazhdani³

et al. 2016

J Ultrasound

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Objective To evaluate the accuracy of contrast-enhanced ultrasound (CEUS) in comparison to CT angiography (CTA) to identify and classify endoleaks following abdominal aortic aneurism repair with endoprosthesis. Materials and methods A retrospective analysis of 181 patients treated with EVAR, from September 2009 to September 2014, was performed. Patients were evaluated with CEUS, CTA and angiography in the cases requiring treatment. Sac diameter, sac integrity, identification and classification of endoleaks were taken into consideration. Sensitivity, specificity, accuracy and negative predictive values were considered for each modality of endoleak identification. Results Forty-two endoleaks (23.2%; type II: 39 cases, type III: 3 cases) were documented. Sensitivity and specificity of CEUS and CT were, respectively, 97.6 and 90.5, 100 and 100%. In two cases, CEUS was able to better classify endoleaks compared to CT. Conclusions CEUS accuracy to identify endoleaks following EVAR is similar to CT. CEUS should be considered as an effective modality for the long-term surveillance of EVAR because of its capability to correctly classify endoleaks with no ionizing radiation exposure.Keywords Contrast-enhanced ultrasound Á CT Á Endoleak Riassunto Obiettivi dello studio Valutare l'accuratezza dell'ecocontrastografia (CEUS), confrontandola con angiografia con tomografia computerizzata (CT) per l'identificazione degli endoleak dopo trattamento di aneurisma dell'aorta addominale con endoprotesi. Materiali Da Settembre 2008 a Dicembre 2014, 181 pazienti consecutivi trattati con EVAR sono stati valutati con CEUS, CTA, ed anche con angiografia nei casi da ritrattare. Sono stati valutati: diametro della sacca, valutazione dell'integrita della sacca, identificazione e classificazione degli endoleaks. Sensibilità, specificità, accuratezza e valore predittivo negativo sono stati valutati per ogni modalita nell'identificazione degli endoleak. Risultati Quarantadue endoleak (23.2%; tipo II: 39 casi, tipo III: 3 casi) sono stati documentati. La Sensibilita della CEUS e della TC e stata rispettivamente del 97.6, 90.5%, mentre la specificita per entrambe e stata del 100%. In due casi la CEUS e stata in grado di classificare meglio gli endoleak rispetto alla CT. La sacca aneurismatica presentava alla CEUS e CDUS un diametro massimo compreso tra 39-82 mm, mentre alla TC tra 38 e 78 mm, senza significativa differenza tra le due metodiche. Conclusioni L'accuratezza della CEUS nell'identificazione degli endoleak e nella misurazione della sacca dopo EVAR, e simile alla TC con maggiore sensibilita ma analoga specificita. La CEUS e da considerarsi una modalita efficace per la sorveglianza a lungo termine degli EVAR in quanto capace di classificare correttamente gli endoleak senza esposizione a radiazioni ionizzanti.Parolechiave Contrast-enhanced ultrasound Á CT Á Endoleak

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Section: Resultssupporting

confidence: 62%

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

David

Cantisani

Grazhdani³

et al. 2016

J Ultrasound

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“…CEUS has been shown to be as sensitive as CTA in detecting the type of endoleaks that would normally warrant an immediate intervention (types I and III) and can be more accurate in picking up slow endoleaks (type II) that CTA might miss or have difficulty detecting due to artefacts. [13][14][15] Minutes after contrast injection in CTA (the venous phase), the contrast density, within the aorta and an endoleak, is relatively low compared with the arterial phase. With CEUS, contrast resolution remains relatively high for a few minutes before significant depletion of contrast medium from cavitation or dissolution of microbubbles.…”

Section: Discussionmentioning

confidence: 99%

Late‐onset type I endoleak characterized by contrast enhanced ultrasound after endovascular repair of aortic aneurysm

Gifford

Cheong

Teoh

2017

J of Clinical Ultrasound

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We report in the case of a patient with an intra-abdominal aortic aneurysm treated with endovascular aneurysm repair (EVAR) who developed renal impairment during the period of follow up. The repair was complicated with an early-onset type II endoleak which later evolved into a late-onset type I endoleak. It was treated with proximal extension of stent graft, with treatment success and follow-up documented on contrast enhanced ultrasound (CEUS). This case illustrates the usefulness of CEUS in post-EVAR surveillance and emphasizes the need for life-long monitoring as late-onset complications are not uncommon.

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“…Chung et al conducted a meta‐analysis and systematic review involving 454 patients to evaluate whether delayed EL‐II was detected during EVAR surveillance. The authors concluded that the dynamic nature of CEUS allowed better visualization of this type of endoleak than CTA.…”

Section: Discussionmentioning

confidence: 99%

Advantages of contrast‐enhanced ultrasonography over computed tomography for the detection of persistent type II endoleak after embolization: A case report

Cury

Godoy

et al. 2016

J of Clinical Ultrasound

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The aim of this case report is to describe the use of contrast-enhanced ultrasonography in the detection of a type II endoleak after prior embolization with Onyx. A 74-year-old male patient with hypertension previously underwent endovascular repair of a 7.1-cm infrarenal aortic aneurysm. CT angiography surveillance revealed a type II endoleak associated with aneurysm sac expansion. Selective transarterial embolization of the endoleak was performed, but it was not possible to detect the persistent endoleak using CT angiography because of image artifacts caused by Onyx. Contrast-enhanced ultrasonography enabled us to detect the persistent endoleak in this patient. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:522-526, 2016.

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Contrast-enhanced ultrasound (CEUS) versus computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients. Are delayed type II endoleaks being missed? A systematic review and meta-analysis

Abstract: The CEUS with its dynamic nature and longer scanning window demonstrated to be a highly sensitive modality for endoleak detection in comparison to CTA in delayed endoleaks type II.

Cited by 50 publications

References 38 publications

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale

Late‐onset type I endoleak characterized by contrast enhanced ultrasound after endovascular repair of aortic aneurysm

Advantages of contrast‐enhanced ultrasonography over computed tomography for the detection of persistent type II endoleak after embolization: A case report

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