Key result
Color duplex ultrasonography demonstrated a pooled sensitivity of 69% (95% CI 52-87%) and specificity of 91% (95% CI 87-95%) for detecting endoleaks after aortic endografting compared to CT.
Why the study?
Does color duplex ultrasonography have sufficient diagnostic accuracy compared to contrast-enhanced CT for detecting endoleaks after aortic endografting?
Systematic Review (n=711)
Yes
Does color duplex ultrasonography have sufficient diagnostic accuracy compared to contrast-enhanced CT for detecting endoleaks after aortic endografting?
Effect estimate: Sensitivity 69% (95% CI 52-87)
Color duplex ultrasonography lacks sufficient sensitivity (69%) to replace contrast-enhanced CT for the routine detection of all endoleaks after aortic endografting.
Color duplex US lacks sensitivity to replace CT for post-EVAR endoleak surveillance; confirms its role as adjunct rather than alternative.
PURPOSE: To synthesize the available evidence regarding the diagnostic accuracy of color duplex ultrasonography (CDU) versus the accepted gold-standard of contrast-enhanced computed tomography (CT) for the detection and classification of endoleaks after aortic endografting. METHODS: A systematic search of the literature was conducted using electronic bibliographical databases and other means to gather articles published between 1991 and 2004. Articles were scrutinized against inclusion/exclusion criteria that broadly followed the QUADAS quality assessment guidelines. The results of diagnostic CDU were expressed for each study as a 2x2 contingency table, and summary statistics (sensitivity/specificity with 95% confidence intervals [CI]) were calculated. Pooled and random effects meta-analyses were performed. RESULTS: Eight published studies and 2 unpublished studies from Charing Cross and St. George's Hospitals (711 patients, 1355 paired scans performed > or = 1 month after endografting) were eligible for inclusion. From meta-analyses, the pooled sensitivity of CDU (versus CT as the gold standard) was 69% (95% CI 52% to 87%) and the specificity of CDU was 91% (95% CI 87% to 95%). These parameters did not appear to vary over time when a smaller dataset of 117 patients with 239 paired scans was used to compare CT and CDU specifically at 3, 12, and 24 months after endografting. Endoleak classification data, which was derived from only 5 small studies, indicated that CDU appeared to have better diagnostic accuracy in detecting type I or type III endoleaks compared with type II endoleaks; however, the data were insufficient for statistical analysis. CONCLUSIONS: CDU currently does not have sufficient diagnostic accuracy for the detection of all endoleaks in routine clinical practice. The diagnostic accuracy of CDU may improve if type II endoleaks are ignored.
No takes yet. Share an insight, caveat, or question.
Ashoke et al. (2005) conducted a systematic review in Endoleak after aortic endografting (n=711). Color duplex ultrasonography (CDU) vs. Contrast-enhanced computed tomography (CT) was evaluated on Detection of endoleaks (Sensitivity) (Sensitivity 69%, 95% CI 52-87). Color duplex ultrasonography demonstrated a pooled sensitivity of 69% (95% CI 52-87%) and specificity of 91% (95% CI 87-95%) for detecting endoleaks after aortic endografting compared to CT.
Synapse has enriched 2 closely related papers on similar clinical questions. Consider them for comparative context: