title: A Systematic Review of Ultrasound or Magnetic Resonance Imaging Compared With Computed Tomography for Endoleak Detection and Aneurysm Diameter Measurement After Endovascular Aneurysm Repair.
abstract: To analyze the literature comparing ultrasound [duplex (DUS) or contrast-enhanced (CEUS)] or magnetic resonance imaging (MRI) with computed tomography angiography (CTA) for endoleak detection and aneurysm diameter measurement after endovascular aneurysm repair (EVAR).
  
  
  
  A systematic review identified 31 studies that included 3853 EVAR patients who had paired scans (DUS or CEUS vs CTA or MRI vs CTA) within a 1-month interval for identification of endoleaks during EVAR surveillance. The primary outcome was the number of patients with an endoleak detected by one test but undetected by another test. Results are presented for all endoleaks and for types I and III endoleaks only. Aneurysm diameter measurements between CTA and ultrasound were examined using meta-analysis.
  
  
  
  Endoleaks were seen in 25.6% (985/3853) of patients after EVAR. Fifteen studies compared DUS with CTA for the detection of all endoleak types. CTA had a significantly higher proportion of additional endoleaks detected (214/2346 vs 77/2346 for DUS). Of 19 studies comparing CEUS with CTA for the detection of all endoleak types, CEUS was more sensitive (138/1694) vs CTA (51/1694). MRI detected 42 additional endoleaks that were undetected by CTA during the paired scans, whereas CTA detected 2 additional endoleaks that MRI did not show. CTA had a similar proportion of additional types I and III endoleaks undetected by CEUS or MRI. Of 9 studies comparing ultrasound vs CTA for post-EVAR aneurysm diameter measurement, the aneurysm diameter measured by CTA was greater than ultrasound (mean difference -1.70 mm, 95% confidence interval -2.45 to -0.96, p<0.001).
  
  
  
  This study demonstrated that CEUS and MRI are more accurate than CTA for the detection of post-EVAR endoleaks, but they are no better than CTA for detecting types I and III endoleaks specifically. Aneurysm diameter differences between CTA and ultrasound should be considered when evaluating the change in aneurysm diameter postoperatively.
authors.affiliation: Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Guo
authors.affiliation: Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China zjcwch@163.com.
authors.forename: Jichun
authors.initials: J
authors.lastname: Zhao
authors.affiliation: Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.affiliation: Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Ding
authors.initials: D
authors.lastname: Yuan
authors.affiliation: Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Guojun
authors.initials: G
authors.lastname: Zeng
authors.affiliation: Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Xiong
authors.affiliation: Department of Vascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
authors.forename: Xiaojiong
authors.initials: X
authors.lastname: Du
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000628:therapy*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation; D003287:Contrast Media; D057867:Endoleak / Q000000981:diagnostic imaging*; D057510:Endovascular Procedures; D006801:Humans; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: abdominal aortic aneurysm; aneurysm diameter; computed tomography angiography, contrast-enhanced ultrasound; duplex ultrasound, endoleak; endovascular aneurysm repair; magnetic resonance imaging; surveillance; ultrasonography