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Contrast-enhanced ultrasound (CEUS) has emerged as a promising alternative, although prospective comparative data remain limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this prospective, single-centre diagnostic accuracy study, 30 consecutive patients (mean age 78.5\u2009\u00b1\u20097.1\u00a0years; 70% male) undergoing EVAR follow-up were evaluated with duplex ultrasound (DUS), CEUS (SonoVue\u00ae), and CTA within a 30-day interval. CTA served as the reference standard. Diagnostic performance metrics were calculated with 95% confidence intervals (CIs) according to STARD recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Endoleaks were identified in 11 patients (36.7%). CTA detected 8 cases (26.7%), CEUS 9 (30.0%), and DUS 4 (13.3%). CEUS demonstrated high sensitivity (87.5%; 95% CI 47.3\u201399.7%) and specificity (90.9%; 70.8\u201398.9%), with overall accuracy of 90.0% (73.5\u201397.9%). In contrast, DUS showed limited sensitivity (33.3%; 9.9\u201365.1%) despite perfect specificity (100%), yielding lower accuracy (73.3%). Inter-modality agreement was 83.3%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>CEUS demonstrates high diagnostic accuracy for endoleak detection after EVAR and represents a robust, radiation-free alternative to CTA for longitudinal surveillance. Given its favourable safety profile and diagnostic performance, CEUS should be considered a first-line imaging modality in routine follow-up, with CTA reserved for equivocal findings or pre-interventional planning. These results support a paradigm shift toward CEUS-based surveillance strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s40477-026-01182-4","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:16:56Z","timestamp":1785172616000},"page":"639-646","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of contrast-enhanced ultrasound versus duplex ultrasound and computed tomography angiography for endoleak detection after EVAR: a prospective comparative study"],"prefix":"10.1007","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6488-0826","authenticated-orcid":false,"given":"Wellington Gianoti","family":"Lustre","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9563-8047","authenticated-orcid":false,"given":"Libnah","family":"Leal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinicius","family":"Cardoso","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9487-9770","authenticated-orcid":false,"given":"Mateus Aves Borges","family":"Cristino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9943-3583","authenticated-orcid":false,"given":"Carolina Dutra Queiroz","family":"Flumignan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6440-8011","authenticated-orcid":false,"given":"Ronald Luiz Gomes","family":"Flumignan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Eduardo","family":"de Amorim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7996-3269","authenticated-orcid":false,"given":"Luis Carlos Uta","family":"Nakano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"1182_CR1","doi-asserted-by":"publisher","first-page":"1863","DOI":"10.1056\/NEJMoa0909305","volume":"362","author":"RM Greenhalgh","year":"2010","unstructured":"Greenhalgh RM, Brown LC, Powell JT, UK Evar Trial Investigators et al (2010) Endovascular versus open repair of abdominal aortic aneurysm. 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