探讨高帧频超声造影（H-CEUS）对腹主动脉瘤血管腔内覆膜支架植入术（EVAR）术后Ⅱ型内漏来源动脉的显示价值。

收集四川大学华西医院2020年5月至8月的EVAR术后患者9例，所有的患者常规超声均怀疑Ⅱ型内漏。使用迈瑞Resona 7超声仪，分别用常规超声、传统超声造影（CEUS）及H-CEUS进行评估，观察有无内漏并寻找内漏的来源动脉，测量血流速度。由1名有经验的超声医师做传统的CEUS和H-CEUS检查，观察支架及瘤腔显影时间，计算显影时间差及寻找来源动脉。留存动态及静态图像，由另外2名有经验的超声医师回顾信息，根据2种造影来源动脉的可辨识度及图像质量情况进行评分。采用配对样本t检验比较入瘤腔方向峰值流速和出瘤腔方向最大流速的差异；采用非参数检验的Wilcoxon符号秩检验比较传统CEUS对来源动脉成像质量评分与H-CEUS成像质量评分的差异。

瘤体大小平均（5.2±1.1）cm，并且所有患者瘤体无明显长大。1例患者术后3个月时内漏自愈。9例患者中1例患者CEUS及H-CEUS未见内漏，即常规超声检查呈假阳性，8例患者常规超声检查发现的内漏经CEUS证实。8例患者内漏均为Ⅱ型内漏，其中3例来源于单支动脉，余5例为2支动脉以上的内漏。内漏来源于肠系膜下动脉和（或）腰动脉。彩色多普勒超声发现13支动脉来源动脉，但CEUS发现15支来源动脉。内漏来源动脉图像质量评分中位数：传统CEUS为1.0分，H-CEUS为3.0分，两者比较差异具有统计学意义（Z=-3.035，P=0.002）。

在EVAR术后Ⅱ型内漏的诊断中，H-CEUS较传统CEUS能更能清晰地显示来源动脉。

To investigate the role of high-frame-rate contrast-enhanced ultrasound (H-CEUS) in displaying the source artery of type Ⅱ endoleak after endovascular aneurysm repair (EVAR).

A total of nine patients after EVAR were included in the study at our hospital from the end of May to the beginning of August 2020. All of the patients were suspected of having type Ⅱ endoleak according to conventional ultrasound. The patients were evaluated by conventional ultrasound, conventional contrast-enhanced ultrasound (CEUS), and H-CEUS by using Mindray Resona 7 ultrasound instrument to observe whether there was endoleak and to find the source artery of endoleak. Traditional CEUS examination and H-CEUS were performed by an experienced physician to observe the time to display the stent and aneurysm cavity to calculate the time difference and to find the source artery. Dynamic and static images were preserved and reviewed by two other experienced ultrasound physicians, and scored according to the identifiability and image quality of the two angiographic sources. Paired sample t test was used to compare the difference of the peak velocity in the direction of inflow and the maximum velocity in the direction of outflow. Wilcoxon signed-rank test was used to compare the difference of imaging quality score of source arterial imaging by conventional CEUS with that of H-CEUS.

The average size of the abdominal aortic aneurysm was (5.2±1.1) cm, and there was no obvious aneurysm growth in all patients. One patient recovered 3 months after EVAR. There was no endoleak in one of the nine patients, which was false positive finding by color Doppler ultrasound. Eight cases of endoleak found by color Doppler ultrasound were confirmed by CEUS. Eight cases were diagnosed with type Ⅱ endoleak, of which three were from a single artery, and the remaining five were from more than two arteries. The endoleak originated from the inferior mesenteric artery (IMA) and/or lumbar artery (LA). Color Doppler ultrasound showed 13 arteries, but CEUS found 15 arteries. The median of image quality score of endoleak source artery was 1.0 for conventional CEUS and 3.0 for H-CEUS, and there was a significant difference between them (Z=-3.035, P=0.002).

In the diagnosis of type Ⅱ endoleak after EVAR, H-CEUS can more clearly show the source artery than the traditional CEUS.