感染性主动脉瘤的CT影像学分析与诊断

Computed Tomography Imaging Analysis and Diagnosis of Infective Native Aortic Aneurysm

目的:通过感染性主动脉瘤和非感染性主动脉瘤的对照研究,寻找感染性动脉瘤特征性CT影像学表现,建立诊断模型。方法:纳入2013~2022年间于山东省立医院就诊的感染性动脉瘤病人87例,并应用倾向性评分匹配选择非感染性动脉瘤病例87例,对比两组间CT影像学表现,建立列线图影像学诊断模型。结果:囊性(52.9% vs. 16.1%),分叶状(40.2% vs. 3.4%)在感染性动脉瘤中更常见,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%)在非感染性动脉瘤中罕见。感染性动脉瘤中的瘤壁钙化不能作为诊断依据(P = 0.158),多发动脉瘤在感染与非感染性动脉瘤组间无明显差异。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。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感染性动脉瘤提示特征还有待进一步讨论。

Objective: To determine the CT imaging features of infective native aortic aneurysm (INAA) by comparing the infective native aortic aneurysm and non-infective aortic aneurysm (NIAA), and to build a nomogram diagnostic model. Methods: 87 cases of INAA patients during 2013~2022 were involved, and 87 cases of NIAA patients were selected by propensity-scoring match method. The difference of CT characteristics between two groups was compared. A nomogram diagnostic model based on the CT features was built. Results: Saccular (52.9% versus 16.1%), multilobular (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. There was no significant difference of multiple aneurysms between INAA and NIAA. A nomogram model based on features as saccular, multilobular, periaortic gas, fluid and mural thrombus was constructed. 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.