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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

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Abstract

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.

Riassunto

Obiettivi dello studio

Valutare l’accuratezza dell’eco-contrastografia (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.

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Author information

Authors and Affiliations

  1. Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Via Consolare Valeria 1, 98124, Messina, Italy

    E. David, A. Bottari & G. Ascenti

  2. Department of Radiology, Oncology, and Anatomo Pathology, “Sapienza” University of Rome, Rome, Italy

    V. Cantisani, F. Fanelli, M. Di Segni, N. Di Leo, M. Ciccariello & F. D’Ambrosio

  3. Associazione dei Cavalieri Italiani Sovrano Militare Ordine di Malta; Poliambulatorio Roma, Eur Piazza Guglielmo Marconi 12, 00144, Rome, Italy

    H. Grazhdani

  4. Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy

    L. Di Marzo & L. Venturini

  5. Department of Medicine and Health Sciences, University of Molise, Contrada Tappino, 86100, Campobasso, Italy

    L. Brunese

  6. University Hospital of Pavia, Viale Camillo Golgi 19, 27100, Pavia, Italy

    F. Calliada

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  1. E. David
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Corresponding author

Correspondence to E. David.

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Funding

This study was not funded.

Conflict of interest

Vito Cantisani lectured for Bracco, Samsung, Toshiba and Fabrizio Calliada lectured for Hitachi and Mindray but they did not receive funding. The other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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David, E., Cantisani, V., Grazhdani, H. et al. 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. J Ultrasound 19, 281–287 (2016). https://doi.org/10.1007/s40477-016-0222-5

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