ReviewCVIR endovascular2026
Contrast-enhanced ultrasound versus CT angiography for endoleak detection after EVAR: a reference-standard-aware systematic review and meta-analysis.
Review in CVIR endovascular, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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3 authors.
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Abstract
purposeTo 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.
methodsWe 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.
resultsEighteen 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; I
conclusionsCEUS 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.
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