Contrast-enhanced ultrasound versus CT angiography for endoleak detection after EVAR: a reference-standard-aware systematic review and meta-analysis.

Authors

Rafaella Brandão de Melo Soares, Rafael de Negreiros Botan, Iruena Moraes Kessler

Published in

CVIR endovascular. Volume 9. Issue 1. Jul 22, 2026. Epub Jul 22, 2026.

Abstract

To evaluate contrast-enhanced ultrasound (CEUS) for endoleak detection after endovascular aneurysm repair (EVAR) against CT angiography (CTA) or CTA-centered composite references, explicitly treating CTA as an imperfect reference standard.
We searched PubMed/MEDLINE, Europe PMC, Crossref, OpenAlex, and performed an institutional Embase/Scopus coverage audit through 13 May 2026, with citation checking from prior reviews and included-study bibliographies. Eligible studies included adults undergoing paired CEUS and CTA or CTA-centered reference imaging after EVAR. The primary estimand was apparent CEUS diagnostic performance for any endoleak at the paired-examination level. An approximate bivariate logit-normal random-effects model was used as the primary meta-analysis; separate logit random-effects models, leave-one-out analysis, source-basis sensitivity analysis, and paired discordance testing were prespecified support analyses.
Eighteen all-endoleak studies contributed 2064 participants and 2452 paired examinations. The bivariate model estimated CEUS sensitivity as 0.905 (95% CI 0.869-0.932) and specificity as 0.943 (95% CI 0.890-0.971). Separate logit random-effects estimates were similar: sensitivity 0.909 (95% CI 0.873-0.936; I² = 42.5%) and specificity 0.944 (95% CI 0.892-0.972; I² = 88.7%). Results were consistent in ≤ 30-day and CTA-only subsets. CEUS-positive/reference-negative discordance exceeded CEUS-negative/reference-positive discordance (116 vs 67; ratio 1.73; p = 0.00036).
CEUS shows high apparent diagnostic performance for post-EVAR endoleak detection against CTA-centered references, with sensitivity and specificity both approximately 91-94%. CEUS-positive/reference-negative discordance was more frequent than the reverse and may represent low-flow or delayed endoleaks not captured by CTA-centered reference imaging in some cases. However, substantial specificity heterogeneity and CTA-reference limitations argue against unqualified CTA replacement. CEUS is best supported as a CTA-sparing surveillance and adjudication tool in selected pathways, with CTA retained for baseline structural assessment, graft evaluation, procedural planning, and discordant or high-risk findings.

PMID:
42484972
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.