Clinical Report: Dual-Energy CT Accuracy for Endoleak Detection Post-EVAR

Overview

This systematic review and meta-analysis evaluated the diagnostic accuracy of dual-energy computed tomography (DECT) in detecting endoleaks following endovascular aneurysm repair (EVAR) compared to the conventional triphasic single-energy CT (SECT) protocol. DECT demonstrated high sensitivity and specificity with a significant reduction in radiation dose, supporting its potential as a safer surveillance imaging modality.

Background

Aortic aneurysms are a significant cause of cardiovascular mortality, and endovascular aneurysm repair (EVAR and TEVAR) is the preferred surgical treatment. Lifelong imaging surveillance using triphasic SECT is recommended to detect endoleaks, a complication that can lead to aneurysm rupture. However, the triphasic protocol exposes patients to high cumulative radiation doses, increasing cancer risk. DECT offers dual-energy acquisition allowing elimination of some scan phases, potentially reducing radiation without compromising diagnostic accuracy.

Data Highlights

Key Findings

• DECT protocols demonstrated high diagnostic accuracy for detecting endoleaks post-EVAR, comparable to the triphasic SECT reference standard.
• DECT allows elimination of the true non-contrast phase and potentially one contrast-enhanced phase, reducing radiation exposure.
• Radiation dose reduction with DECT was statistically significant compared to triphasic SECT, lowering patient risk of radiation-induced malignancy.
• Meta-analysis included multiple observational studies with data extracted on true/false positives and negatives to calculate pooled sensitivity, specificity, and DOR.
• DECT biphasic and monophasic protocols detected a proportion of endoleaks comparable to the triphasic SECT, with no significant difference in detection rates.
• Risk of bias was assessed using QUADAS-2, with studies at low or unclear risk included in the analysis.

Clinical Implications

DECT can be considered a reliable alternative to conventional triphasic SECT for surveillance imaging after EVAR, offering equivalent diagnostic performance with substantially reduced radiation exposure. Adoption of DECT protocols may improve patient safety by minimizing cumulative radiation risks during lifelong follow-up. Clinicians should consider integrating DECT into routine post-EVAR surveillance protocols where available.

Conclusion

Dual-energy CT provides accurate detection of endoleaks following endovascular aneurysm repair while significantly reducing radiation dose compared to conventional triphasic single-energy CT. This supports its clinical adoption for safer long-term surveillance.

References

1. European Society for Vascular Surgery Guidelines 2020 -- Management of Aortic Aneurysms
2. PRISMA-DTA Statement 2018 -- Reporting Systematic Reviews of Diagnostic Test Accuracy
3. QUADAS-2 Tool 2011 -- Quality Assessment of Diagnostic Accuracy Studies
4. G*Power 2024 -- Statistical Power Analysis Software