The value of contrast-enhanced ultrasonography in evaluating abdominal aneurysm and comparison by CT angiography
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Objective To compare the capability of contrast-enhanced ultrasonography (CEUS) and CT angiography(CTA)in evaluating abdominal aortic aneurysm. Methods Both CEUS and CTA examinations were performed in 18 patients (diagnosis before surgery in 10 patients, surveillance after surgery in 8 patients). The CEUS contrast agent was Sonovue. The diagnosis and the appearance about abdominal aortic aneurysm, dissecting aortic aneurysm, aortic pseudoaneurysm and the image after operation were compared. Results There were abdominal aortic aneurysm in 5 patients, dissecting aortic aneurysm in 4 patients and aortic pseudoaneurysm without operation in 1 patient. The 8 patients under surveillance after operation including endovascular abdominal aortic aneurysm repair in 4 patients and open repair with artificial vascular in 4 patients. Both CEUS and CTA had the same results. Conclusion The CEUS is comparable to CTA in diagnosing abdominal aortic aneurysm. The CEUS is worthy of application in abdominal aortic aneurysm.Keywords:
Pseudoaneurysm
Contrast-enhanced ultrasound
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The aim of this study was to evaluate computed tomography (CT) in the assessment of abdominal aortic aneurysms with particular reference to their longitudinal extent. Twenty-nine patients were examined by CT, 21 of whom came to surgery. Sixteen of these 21 patients were also examined by ultrasound. At CT the relation of the aneurysm to the renal arteries proximally and the bifurcation distally was noted, along with the definition of the aortic outline. At subsequent surgery the longitudinal relations of the aneurysm and evidence of localized stretching of or leakage from the sac were assessed by an observer without knowledge of the CT scan report. Correct extent of the aneurysm in relation to the renal arteries was predicted by CT in 20 out of 21 patients who underwent surgery. CT assessment with respect to the bifurcation was correct in 16. The CT findings proved correct in one patient with localized stretching of one part of the aneurysm and in one patient where leakage was occurring. CT scanning was found to be superior to ultrasound in our preoperative assessment of the superior extent of abdominal aortic aneurysms. CT is considered to be the investigation of first choice when evaluation an abdominal aortic aneurysm.
Aortic bifurcation
Abdominal aorta
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Digital subtraction angiography
Computed Tomography Angiography
Subtraction
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Objectives This study was designed for evaluation of CEUS (contrast-enhanced ultrasound) for the detection of endoleaks after EVAR (endovascular aortic aneurysms repair) as an alternative to CTA (computed tomography angiography), the gold standard in post-EVAR surveillance. Methods Post-EVAR surveillance of patients who underwent CEUS and CTA was retrospectively analyzed to compare the accuracy of CEUS compared to CTA. For that, the following parameters were analyzed: the largest aneurysm diameter, type of endoleaks, and the time elapsed after EVAR using both surveillance tests. Results The study involved 110 pairs of exams in patients with infrarenal aortoiliac or isolated iliac artery aneurysm, covering predominantly a male population (89%). The time elapsed after EVAR using CEUS or CTA exams were statistically similar, ranging from one to 58 months (mean 12.2) and one to 65 months (mean 9.7), respectively ( p = 0.124). CEUS sensitivity was 75.5%, specificity 96.7%, false positives were 24.5%, and false negatives were 3.3%. The accuracy between the two exams was 87.3%. A secondary analysis, comparing CTA with CEUS as a reference standard, revealed CEUS sensitivity of 24.5%, higher than CTA for detecting endoleaks, with a concordance rate of true positive results of 75.5%. Among the endoleaks detected solely by CEUS (12 cases), one case was type Ia and eleven were type II, while those detected only by CTA (2 cases), one was type Ia and one type II. Additionally, a type II endoleak associated with type Ib, identified by CEUS, was seen as type II for CTA only. There was no difference between the pre-EVAR and the post-EVAR diameters of aortoiliac aneurysm ( p = 0.058), both for CEUS and CTA. Computed tomography angiography, on the other hand, showed significant aneurysm diameter reduction compared to CEUS for isolated iliac artery aneurysms ( p < 0.001). Conclusion Contrast-enhanced ultrasound was more effective than CTA in identifying and characterizing endoleaks in patients undergoing EVAR, especially type II endoleaks. The advantages include efficacy and, particularly, safety, and must be considered in EVAR surveillance protocols so that its use becomes widespread. We understand that CEUS, as a surveillance exam, considerably reduces risks to patients compared to CTA.
Contrast-enhanced ultrasound
Endovascular aneurysm repair
Gold standard (test)
Computed Tomography Angiography
Concordance
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Citations (1)
Digital subtraction angiography
Multislice computed tomography
Magnetic resonance angiography
Abdominal aorta
Computed Tomography Angiography
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Citations (3)
Contrast-enhanced ultrasound
Multidetector computed tomography
Endovascular aneurysm repair
Computed Tomography Angiography
Gold standard (test)
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Citations (26)
The CT scanning findings in 30 cases of the abdominal aortic aneurysm were analysed. The value of CT in diagnosing and following up of the abdominal aortic aneurysms was discussed. CT is recommended in comparison with other imaging technics. Thin slices and enhancement were made in order to show the relationship between aneurysm and the origin of the renal arteries when suspected.
Abdominal aneurysm
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Conventional aortography accurately defines arterial anatomy for the preoperative assessment of abdominal aortic aneurysms (AAA). Helical computed tomography angiography (CTA) allows enhanced visualization of the aneurysm using less invasive, conventional, computed tomography (CT) methods. Also, three-dimensional (3-D) images may be reconstructed which provide perspective not possible with biplanar arteriograms. The authors tested the hypothesis that helical CTA matches the utility of conventional aortography in the preoperative evaluation of infrarenal AAA. Thirty-one patients with a suspected AAA were evaluated by helical CTA, which included 3-D reconstructions using the maximum intensity projection (MIP) technique. Seven of these patients also received conventional aortography after CTA. Three radiologists and 1 surgeon evaluated all the radiographs for the location and size of the aneurysm or thrombus, for patency of the renal and mesenteric vessels, and for iliac artery patency. In the 7 patients for whom both CTA and aortography were performed, the mesenteric and renal arteries were visualized in both tests. The inferior mesenteric artery (IMA) was recorded in 4 of 7 patients by aortography and in 2 of 7 patients by CTA. In addition, CTA provided detail regarding aneurysm size, presence of aneurysm thrombus, and vessel wall calcification that was not provided by conventional angiography. Of the 31 patients who had CTA, 16 received conventional surgical aneurysm repair after their imaging procedure with no significant intraoperative findings that were not present on CTA. These results suggest that helical CTA is a useful technique in the preoperative evaluation of AAAs. The arteriograrn should be reserved for patients with peripheral occlusive disease or for further evaluation of and possible percutaneous transluminal angioplasty of renal or visceral arterial disease.
Aortography
Computed Tomography Angiography
Endovascular aneurysm repair
Inferior mesenteric artery
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Analysed herein are the data of scientific literature over several last years concerning the use of contrast-enhanced ultrasonography (CEUS) of the abdominal portion of the aorta. Based on the results of Russian and foreign studies, the authors analyse feasibility of using CEUS in various pathological conditions of the aorta, as well as sensitivity, specificity, and prognostic value of the method. Also discussed are advantages and limitations of CEUS compared with other imaging techniques. This is followed by determining appropriate approaches to using the methodology of CEUS in examination of patients after endoprosthetic repair of abdominal aortic aneurysms. Finally, described is own experience of using CEUS in examination of a patient with chronic renal insufficiency after aortic endoprosthetic repair.Представлен анализ данных научной литературы за последние несколько лет о применении контрастного усиления в ультразвуковом исследовании (кУЗИ) брюшного отдела аорты. На основании результатов отечественных и зарубежных исследований анализируются целесообразность использования кУЗИ при различных патологических состояниях аорты, чувствительность, специфичность, прогностическая ценность метода. Рассмотрены преимущества и ограничения кУЗИ в сравнении с другими методами визуализации. Определены подходы к использованию методики кУЗИ в исследовании пациентов после эндопротезирования аневризмы брюшного отдела аорты. Представлен результат собственного исследования пациента с хронической почечной недостаточностью после эндопротезирования аорты с использованием кУЗИ.
Contrast-enhanced ultrasound
Abdominal aorta
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Objective To investigate the diagnosis value of aortic aneurysm with MRI.Methods Two radiologist analysed 312 cases MRI of clinically suspected aortic aneurysm retrospectively,and screening 198 cases of aortic aneurysm,analysed by double blind method.Among these patients,there were 112 male and 87 female,aged 9 to 82 years(mean age of 50.4 years).86 cases underwent X-ray angiography(XRA) examination,and 79 cases with operation.Results The MRI showed 22 cases of ture aneurysm,19 of false aneurysm,127 of dissecting aneurysm,26 of Marfan′s syndrome and 4 of compound aneurysm.Contrast analysed the XRA,CT and operation,the sensitivity and accuracy of MRI is 99% and 94%.Conclusion The MRI is an accurate and safe method for detecting aortic aneurysm.
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The study was undertaken for aortic evaluation and to see its usefulness for assessing aortic aneurysm,aortic dissection and pseudoaneurysm by spiral CT angiography (CTA). A total of 28 patients with aorticaneurysm (n=19), aortic dissection (n=5) and aortic pseudoaneurysm (n=4) were included. CTA findingswere compared with ultrasonography in 14, digital subtraction angiography (DSA) in 14, MRI in 9; andsurgical findings in 12 patients. CTA was an excellent imaging modality for comprehensive evaluation ofaortic aneurysm, dissection and pseudoaneurysm combining the advantage of conventional contrast enhancedCT axial images and those of angiography in the form of 3D reformatted images.Key Words: Aortic aneurysm, dissection, pseudoaneurysm, CT angiography.
Pseudoaneurysm
Digital subtraction angiography
Conventional angiography
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