Contrast-enhanced ultrasound versus computed tomographic angiography for surveillance of endovascular abdominal aortic aneurysm repair.
OBJECTIVE
To compare diagnostic accuracy between contrast-enhanced ultrasound (US) and computed tomographic (CT) angiography to detect changes in abdominal aortic aneurysm (AAA) size and endoleaks during follow-up after endovascular aneurysm repair (EVAR).


METHODS
Between May 2006 and December 2008, 83 patients were consecutively enrolled for contrast-enhanced US and CT angiography imaging during surveillance after EVAR, yielding 127 paired examinations. Comparative analysis was performed for the anteroposterior and transverse maximal diameters of the aneurysm sac and for the presence or absence of endoleak, as determined by US and CT angiography.


RESULTS
Contrast-enhanced US demonstrated significantly more endoleaks, predominantly of type II, compared with CT angiography (53% vs 22% of cases). The number of observed agreements was 77 of 127 (61%), indicating a low level of agreement (kappa value of 0.237). US was as accurate as CT angiography in the assessment of maximal aneurysm sac diameters, as shown by Bland-Altman analyses and low coefficients of variation (8.0% and 8.6%, respectively). The interobserver variability for AAA size measurement by US was low, given the interclass correlation coefficients of 0.99 and 0.98 for anteroposterior and transverse maximal diameters, respectively.


CONCLUSIONS
Contrast-enhanced US may be an alternative to CT angiography in the follow-up of patients after EVAR. As US reduces exposure to the biologic hazards associated with lifelong annual CT angiography, including cumulative radiation dose and nephrotoxic contrast agent load, contrast-enhanced US might be considered as a substitute for CT angiography in the surveillance of patients after EVAR.
Ten Bosch
Jan A
JA
Department of Vascular Surgery, Atrium Medical Center, Heerlen, The Netherlands.
Rouwet
Ellen V
EV
Peters
Cecile T H
CT
Jansen
Linda
L
Verhagen
Hence J M
HJ
Prins
Martin H
MH
Teijink
Joep A W
JA
D000368:Aged; D000792:Angiography / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000601:surgery*; D003287:Contrast Media; D005260:Female; D006801:Humans; D008297:Male; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013459:Sulfur Hexafluoride; D025321:Surgery, Computer-Assisted / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000379:methods*
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride