Single-Centre Prospective Comparison Between Contrast-Enhanced Ultrasound and Computed Tomography Angiography after EVAR

OBJECTIVES: To evaluate contrast-enhanced ultrasound (CEUS) as an effective alternative to CT-angiography (CTA) for endoleak detection and aneurismal sac diameter measurement in the follow-up after endovascular abdominal aortic aneurysm repair (EVAR).

METHODS:From January 2006 to December 2010, 395 patients underwent EVAR follow-up with both CTA and CEUS. The diameter of the aneurismal sac and the presence of endoleaks were evaluated in all the 395 paired examinations.

RESULTS: Bland-Altman plots showed a good agreement in aneurismal sac diameter evaluation between the two imaging modalities. The mean diameter was 54.93 mm (standard deviation (SD) ±12.57) with CEUS and 56.01 mm (SD ± 13.23) with CTA. The mean difference in aneurismal sac diameter was -1.08 mm ±

3.3543 (95% confidence interval (CI), -0.75 to -1.41), in favour of CTA. The number of observed agreement in endoleak detection was 359/395 (90.89%). The two modalities detected the same type I and type III endoleaks. McNemar’s χ(2) test confirmed that CTA and CEUS are equivalent in endoleak detection.

CONCLUSIONS: CEUS demonstrated to be as accurate as CTA in endoleak detection and abdominal aortic aneurysm diameter measurements during EVAR follow-up, without carrying the risks of radiation exposure or nephrotoxicity. Even if it cannot be proposed as the sole imaging modality during follow-up, our analysis suggests that it should have a major role. 

PMID: 21962588

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  1. See also:

    Endovascular Abdominal Aortic Aneurysm Repair: Nonenhanced Volumetric CT for Follow-up.
    Bley TA, Chase PJ, Reeder SB, François CJ, Shinki K, Tefera G, Ranallo FN, Grist TM, Pozniak M.
    Radiology. 2009; 253(1):253-262.

  2. Interesting study! Still relatively small when compared with the already published data on CTA. However a very interesting start!

    The conclusions do seem a bit exagerated though, as this is only a comparative study and not a double blinded randomized large study measuring outcomes (which would be the ideal way to evaluate the efficacy of CEUS for EVAR follow-up).

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