Prospective Comparative Analysis of Colour-Doppler Ultrasound, Contrast-enhanced Ultrasound, Computed Tomography and Magnetic Resonance in Detecting Endoleak after Endovascular Abdominal Aortic Aneurysm Repair

Objectives: To assess the accuracy of colour-Doppler ultrasound (CDUS), contrast-enhanced ultrasonography (CEUS), computed tomography angiography (CIA) and magnetic resonance angiography (MRA) in detecting endoleaks after endovascular abdominal aortic aneurysm repair (EVAR). Design: Prospective, observational study. Materials and methods: From December 2007 to April 2009, 108 consecutive patients who underwent EVAR were evaluated with CDUS, CEUS, CTA and MRA as well as angiography, if further treatment was necessary. Sensitivity, specificity, accuracy and negative predictive value of ultrasound examinations were compared with CIA and MRA as the reference standards, or with angiography when available. Results: Twenty-four endoleaks (22%, type II: 22 cases, type III: two cases) were documented. Sensitivity and specificity of CDUS, CEUS, CIA, and MRA were 58% and 93%, 96% and 100%, 83% and 100% and 96% and 100% respectively. CEUS allowed better classification of endoleaks in 10, two and one patients compared with CDUS, CIA and MRA, respectively. Conclusions: The accuracy of CEUS in detecting endoleaks after EVAR is markedly better than CDUS and is similar to CIA and MRA. CEUS seems to be a feasible tool in the long-term surveillance after EVAR, and it may better classify endoleaks missed by other imaging techniques. (C) 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.