Abstract
Purpose
Contrast-enhanced ultrasonography (CEUS) is an appealing alternative to computed tomography angiography (CTA) for the follow-up of patients who underwent endovascular abdominal aortic aneurysm repair (EVAR). We sought to evaluate the accuracy of CEUS compared with a particularly tailored protocol of CTA performed with a 64-row multidetector CT.
Materials and methods
The study prospectively enrolled 88 consecutive patients for CEUS and CTA imaging during follow-up after EVAR, yielding 142 paired examinations. The outcome is represented by three main goals: identification and characterisation of endoleaks, evaluation of graft patency and measurement of aneurysm diameter. Triple-phase CTA was the gold standard.
Results
Sensitivity and specificity of CEUS compared with CTA in endoleak and graft patency evaluation were 91.89% and 100% and 72% and 100%, respectively. A very high correlation between CTA and CEUS diameter measurements was established. CEUS did not appear superior to CTA in endoleak detection, probably because a tailored CTA protocol with a delayed phase (180 s) allows detection of low-flow endoleaks.
Conclusions
Patient management was not different stafollowing CEUS and CTA results. CTA cannot yet be completely replaced, but several limitations (radiation exposure, contrast agent) encourage redefining the routine follow-up imaging modality. We suggest an algorithm of surveillance alternating CTA and CEUS.
Riassunto
Obiettivo
L’ecografia con mezzo di contrasto (CEUS) rappresenta una valida alternativa all’angio-tomografia computerizzata (CTA) nel follow-up dei pazienti sottoposti a trattamento endovascolare di aneurisma aortico addominale (EVAR). Abbiamo voluto valutare l’accuratezza di CEUS confrontata con CTA eseguita con apparecchio multidetettore a 64 strati e protocollo specifico.
Materiali e metodi
Lo studio prospettico ha arruolato 88 pazienti consecutivi indagati con CEUS e CTA durante il follow-up post-EVAR, ottenendo 142 esami appaiati. Sono stati considerati tre parametri: identificazione e caratterizzazione degli endoleak, valutazione della pervietà della protesi, misura del diametro aneurismatico. La CTA trifasica costituiva il gold-standard.
Risultati
Sensibilità e specificità di CEUS versus CTA nella valutazione di endoleak e pervietà endoprotesica sono state 91,89% e 100%, 72% e 100%, rispettivamente. Si è ottenuta una correlazione molto elevata tra le due metodiche nella misurazione dei diametri. CEUS non è apparsa superiore a CTA nell’identificazione degli endoleak, probabilmente grazie al protocollo mirato comprendente la fase tardiva (180 s), che permette di riconoscere anche leak tardivi a basso flusso.
Conclusioni
La gestione dei pazienti non sarebbe cambiata seguendo i risultati CEUS e CTA. Attualmente CTA non può essere completamente sostituita, ma importanti limiti impongono di ridefinire il follow-up strumentale post-EVAR: proponiamo un algoritmo che alterni CEUS e CTA.
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Motta, R., Rubaltelli, L., Vezzaro, R. et al. Role of multidetector CT angiography and contrast-enhanced ultrasound in redefining follow-up protocols after endovascular abdominal aortic aneurysm repair. Radiol med 117, 1079–1092 (2012). https://doi.org/10.1007/s11547-012-0809-x
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DOI: https://doi.org/10.1007/s11547-012-0809-x
Keywords
- Contrast-enhanced ultrasound (CEUS)
- Computed tomography angiography (CTA)
- Endoleaks EVAR
- Abdominal aortic aneurysm