CEUS、CTA和CDUS对EVAR术后内漏检出效果的比较与评价

Comparison and evaluation of CEUS, CTA and CDUS in endoleak detection after EVAR

目的分析对比增强超声(contrast-enhanced ultrasound,CEUS)、彩色多普勒超声(color Doppler ultrasound,CDUS)和CT血管造影(computed tomographic angiography,CTA)3种检查方法在腔内动脉瘤修复术(endovascular aneurysm repair,EVAR)术后患者内漏检出率和分型方面的差异,进而探讨各种影像学检查方法的优缺点和未来CEUS在EVAR术后随访方面的应用前景。方法对2013年1月至2014年3月北京协和医院收治的13例EVAR患者共18例次CEUS和CDUS检查结果和12例次CTA检查结果进行回顾性分析,计算CDUS、CEUS和CTA的内漏检出率,以及各项检查对内漏检出结果的一致性。结果 CEUS、CDUS和CTA的内漏检出率分别为55.6%(10/18),38.9%(7/18)和41.7%(5/12)。CEUS与CDUS相比较,结果一致性较好(κ=0.675),内漏检出率无明显差异(P=0.250);CEUS与CTA相比较,结果一致性较差(κ=0.211),内漏检出率无明显差异(P=0.375)。结论 CEUS的内漏检出率略高于CDUS和CTA,但是不存在明显差异。CEUS尤其有助于隐匿性内漏的检出和内漏分型的判断,可以作为EVAR术后CTA和CDUS检查的有效补充;但是大规模地推广和应用,尚需更多的病例资料的积累和分析。

Objectives To evaluate the results of contrast-enhanced ultrasound （CELTS）, computed tomographic angiography （CTA） and color Doppler ultrasound （CDUS） of endovascular aneurysm repair （EVAR） postoperative patients, analyse their different ability in detecting endoleak and discuss the advantages and disadvantages of various imaging examinations, as well as the applicational prospect of CELTS as routine follow-up examination for post-EVAR patients. Methods Data about the results of CELTS, CDUS and CTA of 13 post-EVAR patients in Peking Union Medical College Hospital （PUMCH） from January 2013 to March 2014 were collected. There were 18 pairs of CEUS and CDUS results, as well as 12 CTA results. Detection rate of CELTS, CDUS and CTA for endoleak was calculated and agreement between results given by different imaging examinations was checked. Results The detection rates of CEUS, CDUS and CTA were 55.6 % （10/18）, 38.9 % （7/18） and 41.7 % （5/12）, respectively. Results given by CEUS shared high level of agreement with those by CDUS （κ=0.675）, and their results had no significant difference （P= 0.250）. Results given by CEUS shared low level of agreement with those by CTA （κ= 0.211）, and their results had no significant difference （P= 0.375）. Conclusions Endoleak detection rate of CEUS is slightly higher than that of CDUS and CTA, but the difference is of no statistical significance. CEUS is especially valuable in detecting latent endoleaks and classifying endoleaks. CEUS may serve as an effective supplement for CTA and CDUS for surveillance of EVAR postoperative patients. However, the application and generalization of CEUS on a large scale depend on the accumulation of more clinical cases and further analysis.