Contrast-enhanced ultrasound (CEUS) versus computed tomography angiography (CTA) in detection of endoleaks in post-EVAR patients. Are delayed type II endoleaks being missed? A systematic review and meta-analysis

Abstract

Purpose: The purpose of this systematic review is to assess the accuracy of contrast-enhanced ultrasound (CEUS) to computed tomography angiography (CTA) for the detection of endoleaks within EVAR surveillance program.Material and methods: A systematic review in Pubmed, Embase and Cochrane database was performed. Articles assessing diagnostic accuracy and comparative modality (CTA vs. CEUS) for endoleaks in adult patients within surveillance programs were retrieved. Methodological assessment was performed, using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tools. The sensitivity and specificity of data were extracted and statistical analysis was performed using MetaDiSc version 1.4.Results: Eight articles were found eligible (n = 454 patients). The pooled sensitivity of CEUS at detecting endoleak is 0.914 (CI 0.866–0.949) and pooled specificity is 0.782 (CI 0.741–0.820).Conclusion: The CEUS with its dynamic nature and longer scanning window demonstrated to be a highly sensitive modality for endoleak detection in comparison to CTA in delayed endoleaks type II.