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Detection of endoleak with enhanced ultrasound imaging: comparison with biphasic computed tomography
Richard G McWilliams1, Janis Martin, Donagh White
1Department of Radiology, Royal Liverpool University Hospital, England. richard@mcwilliams.u-net.com
Insights
Enhanced ultrasound is less reliable than computed tomography (CT) for detecting endoleak after endovascular abdominal aortic aneurysm (AAA) repair, especially for type II endoleaks. CT remains the preferred surveillance method.
Area of Science:
- Vascular Surgery
- Medical Imaging
- Radiology
Background:
- Endovascular abdominal aortic aneurysm (AAA) repair is a common procedure.
- Post-operative surveillance is crucial for detecting complications like endoleak.
- Ultrasound and computed tomography (CT) are imaging modalities used for surveillance.
Purpose of the Study:
- To compare the effectiveness of unenhanced and enhanced ultrasound imaging against biphasic CT in detecting endoleak after endovascular AAA repair.
Main Methods:
- Fifty-three patients underwent 96 follow-up visits post-endovascular AAA repair.
- Ultrasound studies (color Doppler, power Doppler) were performed with and without contrast.
- Biphasic CT scans were obtained on the same day; all studies were independently scored.
Main Results:
- Ultrasound sensitivity for endoleak detection improved with contrast, from 12% (unenhanced color Doppler) to 50% (enhanced power Doppler).
- Enhanced power Doppler missed 9 type II endoleaks detected by CT.
- CT identified endoleaks more reliably than ultrasound, particularly type II endoleaks.
Conclusions:
- Ultrasound, with or without contrast, is less reliable than CT for diagnosing type II endoleak.
- Computed tomography (CT) remains the preferred imaging modality for surveillance after endovascular AAA repair.
Purpose:
To compare unenhanced and enhanced ultrasound imaging to biphasic computed tomography (CT) in the detection of endoleak after endovascular abdominal aortic aneurysm (AAA) repair.
Methods:
Fifty-three patients (44 men; mean age 70 years) were examined during 96 follow-up visits after endovascular AAA repair. All patients had color Doppler and power Doppler ultrasound studies performed before and after the administration of an ultrasound contrast agent. Biphasic (arterial and delayed) CT was performed on the same day, and the ultrasound and CT studies were independently scored to record the presence or absence of endoleak and the level of confidence in the observation.
Results:
The sensitivity of the ultrasound techniques to detect endoleak improved with the use of ultrasound contrast media, ranging from a low of 12% with unenhanced color Doppler to 50% with enhanced power Doppler. However, the enhanced power Doppler failed to detect 9 type II endoleaks identified by CT (86% negative predictive value for endoleak). There were only 2 graft-related endoleaks in the study; one was diagnosed from the ultrasound image, but the other had nondiagnostic ultrasound scans because of poor views.
Conclusions:
Ultrasound scanning with or without contrast enhancement was not as reliable as CT in diagnosing type II endoleak. CT imaging remains our surveillance modality of choice.