This review shows that AAA diagnosis is no longer just about measuring diameter: the strongest evidence now points to a multimodal pathway where ultrasound and CTA remain the clinical backbone, while CEUS, biomechanical modeling, and emerging biomarker panels begin to refine who truly carries higher rupture or surveillance risk. The full paper maps where these newer tools already add real diagnostic value, where they remain premature, and how AAA detection is shifting from simple imaging toward biologically and mechanically informed precision assessment.
Abstract: The aim of this review is to synthesize contemporary evidence regarding the diagnostic modalities for AAA, including the efficacy of screening programs, the accuracy of advanced imaging techniques, and the emergence of novel circulating biomarkers for diagnosis and risk stratification. The review utilises 303 original studies with 443878 total participants (topic deduplicated ΣN). The mapped evidence suggests that abdominal aortic aneurysm diagnosis is now anchored by high-performing imaging, with ultrasonography remaining the principal screening modality and reported sensitivity and specificity reaching 98.9% and 99.9% in screening settings, while computed tomography angiography remains central for anatomic definition and acute rupture assessment, with sensitivity of 98.3% and specificity of 94.9% in suspected rupture. A prominent signal across the evidence map is the shift beyond diameter alone toward multimodal assessment, including biomechanical indices that showed better rupture discrimination than maximal diameter in some studies (area under the curve 0.878 versus 0.789) and biomarker strategies such as D-dimer- and myeloperoxidase-based models with area under the curve values around 0.80 to 0.95. For post-endovascular aneurysm repair surveillance, contrast-enhanced ultrasound repeatedly showed high diagnostic performance and supports a practical radiation-sparing alternative to repeated computed tomography angiography in appropriate patients. At the same time, the evidence base remains heterogeneous, particularly for biomarkers, artificial intelligence tools, and individualized diagnostic thresholds, so these approaches should currently be viewed as promising adjuncts rather than replacements for established imaging pathways. Future research should prioritize externally validated multimodal diagnostic models that combine standardized imaging measurements, clinically usable biomarker thresholds, and prospective testing across screening, emergency, and surveillance populations.
Final search date and database lock: 2026-04-12 13:16:47 CEST
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Total Abstracts/Papers: 1138
Downloaded Abstracts/Papers: 1138
Included original and non-original Abstracts/Papers (all): 326
Included original Abstracts/Papers (Vote counting by direction of effect): 303
Reference Index (links used in paper): 127
Total participants (topic deduplicated ΣN): 443878
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