Color Doppler Ultrasound with Superb Microvascular Imaging Compared to Contrast-enhanced Ultrasound and Computed Tomography Angiography to Identify and Classify Endoleaks in Patients Undergoing EVAR.
BACKGROUND
The aim of the study was to evaluate the diagnostic effectiveness of color Doppler ultrasound (CDUS) with superb microvascular imaging (SMI) compared to contrast-enhanced ultrasound (CEUS), computed tomography (CT) multislice angiography (64 slices), and angiography required for therapeutic reasons, for follow-up after endovascular aneurysm repair (EVAR).


METHODS
From March 2014 to May 2015, 57 patients treated with EVAR were evaluated with CT, CEUS, CDUS, SMI, and angiography in cases requiring treatment. Evaluation included sac diameter, stent-graft integrity, identification, and classification of endoleaks. Sensitivity, specificity, accuracy, and negative and positive predictive values were evaluated for each modality of endoleak identification.


RESULTS
Eight endoleaks (16.3%), all type II, were documented. Sensitivity of CT, CEUS, CDUS and SMI was 88%, 100%, 63%, and 75%, respectively. Specificity of CT, CEUS, CDUS, and SMI was 100%, 100%, 96%, and 98%, respectively With SMI, CDUS sensitivity significantly increased, whereas specificity did not register great differences.


CONCLUSIONS
SMI was more accurate than CDUS but less accurate than CEUS and CT to identify endoleaks after EVAR. SMI could be concretely used in the follow-up phase to increase CDUS accuracy especially in patients who cannot be studied with CEUS or CT.
Department of Radiology, Oncology, and Anatomy Pathology, "Sapienza" University of Rome, Rome, Italy.
Vito
V
Cantisani
Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
Emanuele
E
David
Department of Radiology, Oncology, and Anatomy Pathology, "Sapienza" University of Rome, Rome, Italy.
Donatella
D
Ferrari
Department of Radiology, Oncology, and Anatomy Pathology, "Sapienza" University of Rome, Rome, Italy.
Fabrizio
F
Fanelli
Department of Surgery Pietro Valdoni, Sapienza University, Rome, Italy.
Luca
L
Di Marzo
Department of Radiology, Oncology, and Anatomy Pathology, "Sapienza" University of Rome, Rome, Italy.
Carlo
C
Catalano
Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
Filippo
F
Benedetto
Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy. Electronic address: dr.spinelli@me.com.
Domenico
D
Spinelli
Department of Vascular and Endovascular Surgery, Paracelsus Medical University, KlinikumNürnberg, Nuremberg, Germany.
Athanasios
A
Katsargyris
Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
Alfredo
A
Blandino
Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy.
Giorgio
G
Ascenti
Department of Radiology, Oncology, and Anatomy Pathology, "Sapienza" University of Rome, Rome, Italy.
Ferdinando
F
D'Ambrosio
D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000601:surgery*; D001027:Aortography / Q000379:methods*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D000072226:Computed Tomography Angiography; D003287:Contrast Media / Q000008:administration & dosage*; D057867:Endoleak / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D057510:Endovascular Procedures / Q000009:adverse effects* / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color
D003287:Contrast Media