title: Role of multidetector CT angiography and contrast-enhanced ultrasound in redefining follow-up protocols after endovascular abdominal aortic aneurysm repair.
abstract: OBJECTIVE
  Contrast-enhanced ultrasonography (CEUS) is an appealing alternative to computed tomography angiography (CTA) for the follow-up of patients who underwent endovascular abdominal aortic aneurysm repair (EVAR). We sought to evaluate the accuracy of CEUS compared with a particularly tailored protocol of CTA performed with a 64-row multidetector CT.
  
  
  METHODS
  The study prospectively enrolled 88 consecutive patients for CEUS and CTA imaging during follow-up after EVAR, yielding 142 paired examinations. The outcome is represented by three main goals: identification and characterisation of endoleaks, evaluation of graft patency and measurement of aneurysm diameter. Triple-phase CTA was the gold standard.
  
  
  RESULTS
  Sensitivity and specificity of CEUS compared with CTA in endoleak and graft patency evaluation were 91.89% and 100% and 72% and 100%, respectively. A very high correlation between CTA and CEUS diameter measurements was established. CEUS did not appear superior to CTA in endoleak detection, probably because a tailored CTA protocol with a delayed phase (180 s) allows detection of low-flow endoleaks.
  
  
  CONCLUSIONS
  Patient management was not different following CEUS and CTA results. CTA cannot yet be completely replaced, but several limitations (radiation exposure, contrast agent) encourage redefining the routine follow-up imaging modality. We suggest an algorithm of surveillance alternating CTA and CEUS.
authors.affiliation: Sezione Radiologia, Dipartimento di Scienze Medico-Diagnostiche e Terapie Speciali, Università di Padova, Via Giustiniani 2, Padua, Italy. raffaella.motta@unipd.it
authors.forename: R
authors.initials: R
authors.lastname: Motta
authors.forename: L
authors.initials: L
authors.lastname: Rubaltelli
authors.forename: R
authors.initials: R
authors.lastname: Vezzaro
authors.forename: V
authors.initials: V
authors.lastname: Vida
authors.forename: P
authors.initials: P
authors.lastname: Marchesi
authors.forename: R
authors.initials: R
authors.lastname: Stramare
authors.forename: A
authors.initials: A
authors.lastname: Zanon
authors.forename: M
authors.initials: M
authors.lastname: Battistel
authors.forename: M
authors.initials: M
authors.lastname: Sommavilla
authors.forename: D
authors.initials: D
authors.lastname: Miotto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery*; D003287:Contrast Media; D057867:Endoleak / Q000000981:diagnostic imaging*; D057510:Endovascular Procedures; D005260:Female; D006801:Humans; D007472:Iohexol; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014463:Ultrasonography; D014654:Vascular Patency
chemical_list: D003287:Contrast Media; D007472:Iohexol