A meta-analysis of the diagnostic accuracy of dual-energy computed tomography for endoleak detection after endovascular aneurysm repair

Patients who have undergone endovascular repair of an abdominal or thoracic aortic aneurysm (EVAR or TEVAR) are recommended to undergo lifelong imaging surveillance to detect endoleaks. Gold standard imaging is by triphasic single energy computed tomography (SECT), however, dual-energy CT (DECT) can reduce radiation exposure by reducing the number of scan phases required. The accuracy of DECT in detecting endoleaks is uncertain. This review assessed the diagnostic accuracy of DECT for detecting endoleaks and compared radiation exposure to conventional triphasic SECT.

Observational studies from Scopus and PubMed databases were screened up to 12th June 2024. Ten studies reporting the diagnostic accuracy of patients previously treated by EVAR or TEVAR were included. According to the quality assessment tool for diagnostic accuracy studies (QUADAS-2), all included studies were considered to have a high risk of bias. A meta-analysis of these studies involving 803 scans on 744 patients found that the pooled sensitivity, specificity and diagnostic odds ratio (DOR) of the DECT as compared to the triphasic SECT were 94.0% (95% CI: 88.9%, 96.9%), 98.9% (95% CI: 95.7%, 99.7%), and 266.4 (95% CI: 140.9, 503.8), respectively. A radiation dose reduction by 29–62% was achieved with DECT as compared to the triphasic SECT.

This meta-analysis suggests that DECT has similar diagnostic accuracy to triphasic SECT for diagnosing endoleak after endovascular aneurysm repair. This suggests that DECT could be adopted in clinical practice because of the lower radiation dose as compared to the conventional triphasic SECT.

Question What is the accuracy of dual energy (DE) as compared to triphasic single energy (SE) computed tomography (CT) for diagnosing endoleak after endovascular aneurysm repair?

Findings As compared to triphasic SECT, DECT was accurate in diagnosing endoleak after endovascular aneurysm repair and exposed patients to a lower radiation dose.

Clinical relevance The radiation dose associated with lifelong follow-up CT scans after endovascular aneurysm repair has been linked to an increased risk of cancer. This study suggests that the use of DECT can reduce radiation exposure without compromising the accuracy of diagnosing endoleak.