A meta-analysis of ultrasound imaging in diagnosis of endoleak among patients after endovascular abdominal aortic aneurysm repair

作者：Sun, Chen; Lin, Shu; Zhao, Lin; Xin, Shijie^*

来源：International Journal of Clinical and Experimental Medicine, 2017, 10(1): 1502-1512.

• Ultrasound
• color-Doppler ultrasound
• power color-Doppler ultrasound
• contrast enhanced ultrasonography
• endovascular abdominal aortic aneurysm repair
• endoleak
• meta-analysis

Background: Due to the high expenditure and the harmfulness of ion radiation of tradition computed tomography (CT) in endoleak diagnosis with patients after endovascular abdominal aortic aneurysm repair (EVAR), the alternative diagnostic methods with lower cost and more safety were being investigated. Although ultrasound (US) imaging had great prospect, its clinical sensitivity and specificity remained uncertain. Methods: All the relative publications were searched through PubMed and Embase, irrespective of the language restriction. And studies, that compared one or more US with CT in diagnosis of endoleak among patients after EVAR, were included. The data of true positive, false positive, true negative and false negative in each study were extracted, based on which, the sensitivity and specificity with their 95% confidence intervals (CI) were figured out as outcome. Then a meta-analysis was performed, in view of the significant heterogeneity among different types of US, we also performed the sub-group analysis of color-Doppler ultrasound (CDUS), power color-Doppler ultrasound (PDUS) and contrast enhanced ultrasonography (CEUS). Besides, the summary receiver operating characteristic (SROC) curve was plotted and its area under the curve (AUC) was calculated, which was convenient for latter comparison. Results: Based on results of meta-analysis, CEUS seemed the optimal choice with the largest AUC of 0.936, and its sensitivity was 0.889 with 95% CI from 0.813 to 0.936. And the secondary was CDUS, AUC of which was 0.822, but had the best performance in specificity of 0.887 with 95% CI from 0.826 to 0.929. No overlap in 95% CI of sensitivity indicated the significant difference between CDUS and CEUS, while there was less discrepancy in specificity. In terms of PDUS, it was insufficient in both items with AUC of 0.803. Besides, CEUS had higher positive ratio in general, when compared with CTA. Conclusion: CEUS with good comprehensive performance in sensitivity and specificity of diagnosing endoleak was recommended to be an alternate of CT. Because of the good performance, especially in specificity, CDUS also can be popularized as a primary or assisted diagnosis. The efficacy of PDUS remained uncertain. And more high-quality studies should be conducted for further research to reach a more powerful conclusion, so the present clinical diagnosis selection needed to take an adequate consideration of patients' situation.

• 出版日期2017
• 单位中国医科大学