Abstract

PurposeThe aim of the study was to assess the effectiveness of Superb Micro-vascular Imaging (SMI) as an alternative to Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography Angiography (CTA) for endoleak detection and classification in patients followed up after endovascular abdominal aortic aneurysm repair (EVAR).Materials and methodsFrom May 2015 to January 2017, 30 patients underwent post-EVAR follow-up with Color Doppler Ultrasound (CDUS), CEUS, SMI, and CTA examinations. Aneurysmal sac diameter and graft patency were evaluated; endoleaks were identified and classified. Sensitivity, specificity, and accuracy values were calculated for each of the four diagnostic methods of endoleak detection. A percentage of agreement and Cohen’s Kappa coefficient were calculated for comparison of methods in terms of endoleak identification.ResultsCTA revealed fifteen endoleaks (50%): three type Ia, nine type II, and three type III. The sensitivity of CDUS, CEUS, and SMI relative to CTA was 27%, 100%, and 100%, respectively. Specificity was 93%, 93%, and 93%, respectively. Accuracy was 60%, 97%, and 97%, respectively. There were no differences between SMI and CEUS in terms of sensitivity, specificity, or accuracy (100%, 93%, and 97%). We do not observe statistically significant differences between CTA, CEUS, and SMI concerning endoleak identification ability. The weakest method in endoleak identification was CDUS.ConclusionsThe analysis showed that SMI is effective, repeatable, and comparable with the CEUS modality in identification endoleaks after EVAR; it may be considered as a potential tool to monitor patients after EVAR implantation, especially those with renal insufficiency or with an allergy to any contrast media.

Highlights

  • The aim of the study was to assess the effectiveness of Superb Micro-vascular Imaging (SMI) as an alternative to Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography Angiography (CTA) for endoleak detection and classification in patients followed up after endovascular abdominal aortic aneurysm repair (EVAR)

  • CTA is unsuitable for detecting some types of slow endoleaks which can be visualized with CEUS, MRA [20,21,22], or, as we have shown in the present study, SMI

  • The first case report about the use of SMI for EVAR surveillance comes from our research team; we demonstrated promising results of using SMI for endoleak detection, comparing the method with Color Doppler Ultrasound (CDUS), CEUS, and CTA [4]

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Summary

Introduction

The aim of the study was to assess the effectiveness of Superb Micro-vascular Imaging (SMI) as an alternative to Contrast-Enhanced Ultrasound (CEUS) and Computed Tomography Angiography (CTA) for endoleak detection and classification in patients followed up after endovascular abdominal aortic aneurysm repair (EVAR). The use of Computed Tomography Angiography (CTA), which is currently recommended for the follow-up of patients undergoing EVAR, puts the patients at risk of receiving high doses of ionizing radiation and exposes them to the repetitive impact of nephrotoxic X-ray contrast [1, 2] Another method used for EVAR follow-up is ultrasound, which is a well-established and non-invasive diagnostic tool with real-time tissue harmonic imaging enabling diagnosis and prompt implementation of a. The rate of adverse reactions reported for microbubbles is low, and no contrast-induced effects on renal function have been observed [2]; notwithstanding, the method’s requirement of intravenous contrast agents remains a disadvantage

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