Detection of endoleak with enhanced ultrasound imaging: comparison with biphasic computed tomography.
OBJECTIVE
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.
McWilliams
Richard G
RG
Department of Radiology, Royal Liverpool University Hospital, England. richard@mcwilliams.u-net.com
Martin
Janis
J
White
Donagh
D
Gould
Derek A
DA
Rowlands
Peter C
PC
Haycox
Alan
A
Brennan
John
J
Gilling-Smith
Geoffrey L
GL
Harris
Peter L
PL
D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D011134:Polysaccharides; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508