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  • Title: [Value of contrast-enhanced ultrasonography in detection of endoleak after endovascular repair of infrarenal abdominal aortic aneurysm].
    Author: Ma C, Zhang J, Xiao M, Kang N, Chen YH, Dai XC.
    Journal: Zhonghua Yi Xue Za Zhi; 2023 Jul 18; 103(27):2106-2111. PubMed ID: 37455129.
    Abstract:
    Objective: To investigate the value of contrast-enhanced ultrasound in detecting endoleak after endovascular repair of infrarenal abdominal aortic aneurysm (EVAR). Methods: The postoperative follow-up data of 102 patients with infrarenal abdominal aortic aneurysm treated with EVAR in Tianjin Medical University General Hospital from August 2015 to December 2021 were retrospectively analyzed. There were 79 males and 23 females, aged 50-91 (69.6±7.6) years old. Using CT angiography (CTA) as the gold standard for diagnosing endoleaks, the effectiveness of contrast-enhanced ultrasound and CDUS in detecting endoleaks was evaluated by paired design chi-square test, and the Kappa value was calculated for consistency test. Patients were divided into groups according to body mass index (BMI), and the number of false-negative endoleaks detected by contrast-enhanced ultrasound in each group was calculated, and its ratio to the actual number of endoleaks was calculated to evaluate whether BMI was related to false-negative ultrasound-enhanced ultrasound. Results: A total of 203 follow-up visits met the inclusion criteria. Endoleaks were detected 36 times (17.7%) by CTA, 31 times (15.3%) by contrast-enhanced ultrasound, 16 times (7.9%) by CDUS, and they all detected type Ⅰ, type Ⅱ and type Ⅲ endoleaks. There was no significant difference between contrast-enhanced ultrasound and CTA in endoleak detection rate and determination of endoleak types (endoleak detection rate: 15.3% vs 17.7%; determination of endoleak types: type Ⅰ 4 vs 4, type Ⅱ 26 vs 31, type Ⅲ 1 vs 1; all P>0.05). CDUS and CTA had statistically significant differences in the detection rate of endoleaks and determination of endoleak types (endoleak detection rate: 7.9% vs 17.7%; determination of endoleak types: type Ⅰ 4 vs 4, type Ⅱ 11 vs 31, type Ⅲ 1 vs 1; all P<0.001). Compared with CTA, contrast-enhanced ultrasound has a sensitivity of 83.3%, a specificity of 99.4%, a Youden index of 0.827, a coincidence rate of 96.6%, a positive predictive value of 96.8%, a negative predictive value of 96.5%, and a Kappa value of 0.875(P<0.001). The two showed excellent diagnostic consistency. All 6 endoleaks not detected by contrast-enhanced ultrasound were type Ⅱ endoleak that did not require treatment, and 3(15.8%) occurred in obese patients with a BMI≥32 kg/m2. Compared with CTA, CDUS had a sensitivity of 38.9%, a specificity of 98.8%, a Youden index of 0.377, a coincidence rate of 88.2%, a positive predictive value of 87.5%, a negative predictive value of 88.2%, and a Kappa value of 0.482 (P<0.001). The two showed moderate diagnostic agreement. The correlation coefficient of the maximum diameter of aneurysms measured by ultrasound and CT was r=0.873(P<0.001). Conclusions: Contrast-enhanced ultrasound is accurate in detecting endoleak after infrarenal EVAR, and its sensitivity to endoleak detection in obese patients with BMI≥32 kg/m2 will be reduced. CDUS is not suitable for detection of endoleak after infrarenal EVAR, but it can be used to monitor the change of the largest diameter of aneurysm after EVAR. 目的： 探讨超声造影检测肾下型腹主动脉瘤腔内修复（EVAR）术后内漏的价值。 方法： 回顾性分析天津医科大学总医院2015年8月至2021年12月行EVAR治疗的102例肾下型腹主动脉瘤患者的术后随访资料，男79例、女23例，年龄50~91（69.6±7.6）岁。以CT血管造影（CTA）为诊断内漏的金标准，分别对超声造影及彩色多普勒超声检测内漏的效能进行评估，并计算Kappa值进行一致性检验。依据体质指数（BMI）对患者进行分组并计算各组超声造影检测出现假阴性内漏次数与实际内漏次数的比值，进而评估患者BMI是否与超声造影出现假阴性相关。 结果： 共203次随访符合纳入标准，其中CTA检测出内漏36次（17.7%）、超声造影检测出内漏31次（15.3%），彩色多普勒超声检测出内漏16次（7.9%），检测类型为Ⅰ型、Ⅱ型、Ⅲ型内漏。超声造影和CTA在内漏检出率、判定内漏分型上差异无统计学意义（内漏检出率：15.3% 比17.7%；判定内漏分型：Ⅰ型4比4，Ⅱ型26比31，Ⅲ型1比1；均P>0.05）；彩色多普勒超声和CTA在内漏检出率、判定内漏分型上差异有统计学意义（内漏检出率：7.9%比17.7%；判定内漏分型：Ⅰ型4比4，Ⅱ型11比31，Ⅲ型1比1；均P<0.001）。超声造影与 CTA比较，检测内漏的灵敏度83.3%、特异度99.4%、约登指数0.827、符合率96.6%、阳性预测值96.8%、阴性预测值96.5%；Kappa值0.875（P<0.001），二者表现出极好的诊断一致性。所有6次超声造影未检出的内漏均为不需处理的Ⅱ型内漏，有3次（15.8%）出现在BMI≥32 kg/m2的肥胖患者。CDUS与CTA比较，检测内漏的灵敏度38.9%、特异度98.8%、约登指数0.377、符合率88.2%、阳性预测值87.5%、阴性预测值88.2%；Kappa值0.482（P<0.001），二者表现出中度的诊断一致性。超声与CT测量动脉瘤最大径相关（r=0.873，P<0.001）。 结论： 超声造影检测肾下型EVAR术后内漏是准确的，它对BMI≥32 kg/m2的肥胖患者内漏检测灵敏度会降低。彩色多普勒超声不适合肾下型EVAR术后内漏检测，但可用于监测EVAR术后动脉瘤最大径变化。.
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