Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands.
Laryngoscope. 2009 Sep;119(9):1745-52. doi: 10.1002/lary.20606.
OBJECTIVES/HYPOTHESIS: Contrast-enhanced computerized tomography (CECT) has become the imaging method of choice in patients with clinical suspicion of a deep neck abscess. The purpose of this retrospective study was to assess the predictive value of the diagnosis of deep neck abscess using CECT.
Retrospective chart review study over a 5-year period from 2002 to 2007 by a blinded observer.
CECT examinations of patients with clinical suspicion of a deep neck abscess were reviewed for the presence of fluid collections, rim enhancement, and abnormal air collections, which we considered as indicative for an abscess. Additionally, the location and extension of the abnormalities were documented.
In this series of 76 patients, 61 adults and 15 children, fluid collections with complete or partial rim enhancement were seen in 65 patients. In two patients large abnormal air collections were seen with nonenhancing fluid accumulation in all deep spaces. Final diagnosis was confirmed by surgery in 57 patients. In 36 patients, two or more adjacent compartments were involved. Nine patients with an abscess were treated successfully by intravenous antibiotics only. The positive predictive value (PPV) for the presence of an abscess was 82% (53/65) if all radiological signs were included. The PPV was 67% (8/12) for fluid collections without rim enhancement. Air within or adjacent to a fluid collection or excessive free air between the fascias indicated an abscess in all cases. Negative predictive value (prediction of no abscess) was 100%.
The predictive value of the diagnosis deep neck abscess by CECT is high, with a PPV of 82%. The presence of air indicates abscess in all cases.
目的/假设：在临床怀疑患有深部脓肿的患者中，增强计算机断层扫描（CECT）已成为首选的影像学方法。本回顾性研究的目的是评估使用 CECT 诊断深部脓肿的预测价值。
通过盲法观察者对 2002 年至 2007 年的 5 年期间的回顾性图表进行回顾性研究。
对有深部颈脓肿临床怀疑的患者进行 CECT 检查，以观察是否存在液体积聚、边缘增强和异常空气积聚，我们认为这些是脓肿的指征。此外，还记录了异常的位置和范围。
在这一系列 76 例患者中，有 61 例成人和 15 例儿童，有 65 例患者出现了完整或部分边缘增强的液体积聚。在两名患者中，可见大量异常空气积聚，所有深部间隙均有非增强性积液积聚。57 例患者通过手术证实了最终诊断。在 36 例患者中，有两个或更多相邻的隔室受累。9 例脓肿患者仅通过静脉抗生素治疗成功。如果包括所有影像学征象，则存在脓肿的阳性预测值（PPV）为 82％（53/65）。无边缘增强的液体积聚的 PPV 为 67％（8/12）。液体积聚内或附近的空气或筋膜之间过多的自由空气在所有情况下均表明存在脓肿。阴性预测值（无脓肿的预测）为 100％。
CECT 对深部颈脓肿的诊断具有较高的预测价值，其阳性预测值为 82％。存在空气表明所有情况下均存在脓肿。
