CEUS versus CT Angiography in the follow-up of abdominal aortic endoprostheses: diagnostic accuracy and activity-based cost analysis
To evaluate diagnostic accuracy and to perform an activity-based cost analysis of contrast-enhanced ultrasonography (CEUS) compared to computed tomography (CT) during annual surveillance after abdominal aortic aneurysm repair with endovascular procedure (EVAR).
Materials and methods
This retrospective study included 137 patients in post-EVAR follow-up over a 6-year period (average post-operatory follow-up without aneurysm sac volumetric reduction). Sensitivity, specificity, positive predictive values, negative predictive values and accuracy were considered for CEUS using CT angiography (CTA) as reference standard. An activity-based cost analysis was performed to evaluate potential savings due to the introduction of CEUS as an alternative to CT, after the first year of postoperative negative controls.
CEUS reported accuracy, sensitivity, specificity, positive predictive values, negative predictive values of 97.4, 96, 100, 100 and 93.1% in the detection and characterization of endoleaks. CEUS cost was € 84.7, and CTA cost was € 157.77, with a differential cost of € 73.07; using CEUS as an alternative to CT allowed a potential saving of 50.052,95 € during follow-up.
CEUS is an accurate and cheap imaging method in post-EVAR follow-up patients, and it could be considered as a valid alternative to CTA, after the first year of negative controls, reducing the number of unnecessary CT examinations.
KeywordsEVAR CEUS CT angiography Endoleak Cost analysis
Compliance with ethical standards
Conflict of Interest
All the authors declare that he/she has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent for CEUS, CT and MR was obtained from all individual participants included in the study. This single-center retrospective study received IRB approval.
- 4.Piscaglia F, Nolsøe C, Dietrich C et al (2011) The EFSUMB guidelines and recommendations on the clinical practice of contrast enhanced ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in der Medizin - European Journal of Ultrasound 33(01):33–59. https://doi.org/10.1055/s-0031-1281676 CrossRefPubMedGoogle Scholar
- 5.Carrafiello G, Laganà D, Recaldini C et al (2006) Comparison of contrast-enhanced ultrasound and computed tomography in classifying endoleaks after endovascular treatment of abdominal aorta aneurysms: preliminary experience. Cardiovasc Intervent Radiol 29(6):969–974. https://doi.org/10.1007/s00270-005-0267-x CrossRefPubMedGoogle Scholar
- 7.Manning BJ, Kristmundsson T, Sonesson B et al (2009) Abdominal aortic aneurysm diameter: a comparison of ultrasound measurements with those from standard and three-dimensional computed tomography reconstruction. J Vasc Surg 50(2):263–268. https://doi.org/10.1016/j.jvs.2009.02.243 CrossRefPubMedGoogle Scholar
- 9.Cantisani V, Ricci P, Grazhdani H et al (2011) Prospective comparative analysis of colour-doppler ultrasound, contrast-enhanced ultrasound, computed tomography and magnetic resonance in detecting endoleak after endovascular abdominal aortic aneurysm repair. J Vasc Surg 53(2):551. https://doi.org/10.1016/j.jvs.2010.12.025 CrossRefGoogle Scholar
- 13.Chung J, Kordzadeh A, Prionidis I et al (2015) 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. J Ultrasound 18(2):91–99. https://doi.org/10.1007/s40477-014-0154-x CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Cantisani V, Grazhdani H, Di Marzo L et al (2016) What is the role of contrast-enhanced ultrasound in the evaluation of the endoleak of aortic endoprostheses? A comparison between CEUS and CT on a widespread scale. J Ultrasound 19(4):281–287. https://doi.org/10.1007/s40477-016-0222-5 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Gruppo di lavoro misto SIRM-SNR IMS (2006) Sago S.p.A. Metologia di determinazione dei volumi di attività e della produttività dei medici radiologi. Nomenclatore SIRM-SNR delle prestazioni radiologiche; p 15, Tav IIIGoogle Scholar