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Meta-Analysis
. 2019 Mar;22(1):65-75.
doi: 10.1007/s40477-019-00364-7. Epub 2019 Feb 15.

Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? A systematic review and meta-analysis

Amer Harky  1 , Ewa Zywicka  2 , Giovanni Santoro  3 , Lucas Jullian  4 , Mihika Joshi  2 , Sameh Dimitri  2
Affiliations
Meta-Analysis

Is contrast-enhanced ultrasound (CEUS) superior to computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients? A systematic review and meta-analysis

Amer Harky et al. J Ultrasound. 2019 Mar.

Abstract

Objective: The purpose of this systematic review and meta-analysis was to assess the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) compared to computed tomography angiography (CTA) for the detection of endoleaks within endovascular aortic aneurysm repair (EVAR) surveillance at time of follow up.

Methods: A comprehensive literature search was undertaken among the four major databases (PubMed, Embase, Scopus and Ovid) to identify all articles assessing diagnostic specificity and accuracy with comparative modality (CEUS vs CTA) for endoleaks in adult patients at time of follow-up following EVAR. Databases where evaluated and assessed to October 2018.

Results: A total of 1773 patients were analysed from across 18 included studies in the quantitative analysis of the parameters of interest. There was no significant difference in detection rate of endoleak type I with detection rate 4.3% for both groups OR 1.09, 95% CI [0.78, 1.53], p = 0.62; type II endoleak detection rate was 22% in the CEUS group vs 23% in the CTA group OR 1.16, 95% CI [0.75-1.79], p = 0.50; while type III detection rate was 1.8% in CEUS group vs 2% in CTA group OR 0.85, 95% CI [0.43, 1.68], p = 0.64. However, the sensitivity rate for endoleak detection was higher in CEUS (p = 0.001) while no difference in specificity rate was noted (p = 0.28). There was higher rate of missed endoleaks in CTA groups (n = 12 vs n = 20).

Conclusion: Evidences from this study suggest that contrast-enhanced ultrasound scan post-EVAR can be utilised as safe and effective method in screening for endoleaks during post-EVAR surveillance without exposing the patient for additional risk of radiation and contrast. CEUS conveys no inferiority to CTA in detecting endoleaks.

Keywords: Angiography; Computerized tomography; Contrast study; EVAR; Ultrasound.

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Conflict of interest statement

Conflict of interest

All authors wish to disclose no conflict of interest.

Ethical approval

This article does not contain any direct studies with human participants performed by any of the authors of this paper.

Informed consent

Not applicable.

Figures

Fig. 1
Fig. 1
Cross-sectional view of the infrarenal aorta. Detection of an endoleak (arrow) using color and pulse-wave ultrasonics [13]
Fig. 2
Fig. 2
Type II endoleak from a lumbar artery following endovascular aortic repair (EVAR). Contrast mode (left) and conventional B-mode (right) simultaneously; after bolus injection of contrast agent extravascular enhancement is shown (arrow) within the aneurysm sack [13]
Fig. 3
Fig. 3
CT- angiogram Type II endoleak from an accessory right renal artery following endovascular aortic repair (EVAR) [13]
Fig. 4
Fig. 4
PRSIMA flow chart of article selection for this systematic review and meta-analysis
Fig. 5
Fig. 5
Forest plot of Type I endoleak detection comparison
Fig. 6
Fig. 6
Forest plot of Type II endoleak detection comparison
Fig. 7
Fig. 7
Forest plot of Type III endoleak detection comparison
Fig. 8
Fig. 8
Forest plot of all type of endoleak detection comparison
See this image and copyright information in PMC

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