感染性主动脉瘤的CT影像学分析与诊断

Computed tomography analysis and diagnosis of infective native aortic aneurysm

目的 通过感染性主动脉瘤(INAA)与非感染性主动脉瘤(NIAA)的CT特征比较,建立诊断模型,探讨INAA与NIAA的CT影像学差异。方法 选取山东省立医院就诊的INAA患者87例(INAA组),应用倾向性评分匹配选取NIAA患者87例(NIAA组),对比两组间CT影像学特征,建立列线图影像学诊断模型。结果 INAA组的平均直径较NIAA组小(56.0mm vs. 60.7mm),差异有统计学意义(P=0.035)。INAA组囊性(52.9%vs. 16.1%)、分叶状(40.2%vs. 3.4%)动脉瘤较NIAA组更常见,管周积气(37.9%vs. 0%)、积液(59.8%vs. 5.7%)和邻近组织感染(54.0%vs. 0%)在NIAA组罕见。瘤壁钙化不能作为INAA的诊断依据(P=0.158)。多发动脉瘤在感染与非感染性动脉瘤组间差异无统计学意义(P=0.116)。依据囊性、分叶状、积气、积液、附壁血栓CT特征建立列线图诊断模型,可依据CT影像学特征较准确诊断INAA。结论 基于CT表现的列线图诊断模型具有较好的准确度和区分度,瘤体无钙化可能提示动脉瘤快速进展,多发性动脉瘤能否作为INAA提示特征还有待进一步观察。

Objective By comparing the CT features of infective aortic aneurysm(INAA)and non-infective aortic aneu⁃rysm(NIAA)to build a nomogram diagnostic model so as to determine the CT imaging differences between INAA and NIAA.Methods 87 patients with INAA and 87 patients with NIAA were selected by propensity-scoring match method.The clinical data were reported and the difference of CT characteristics between two groups was compared.The diagnostic model was built in nomogram.Results INAA had smaller diameter compared to the NIAA(56.0mm).Saccular(52.9%versus 16.1%),multilobu⁃lar(40.2%versus 3.4%)aneurysm were more common in INAA.Periaortic gas(37.9%versus 0%),fluid(59.8%versus 5.7%)and adjacent infection(54.0%versus 0%)were the characteristic imaging features of INAA.A nomogram model based on fea⁃tures as saccular,multilobular,periaortic gas,fluid and mural thrombus was constructed,which can diagnose INAA with high accuracy.Conclusions The nomogram model has a good sensitivity and specificity.Rapid progression can be indicated by the absence of calcification.The indication of the diagnosis of INAA by multiple aneurysms needs further discussion.