主动脉瓣心内膜炎的术前评估：心脏 CT 的表现。

Preoperative evaluation in aortic endocarditis: findings on cardiac CT.

机构信息

Radiologie Centrale, Hôpital Arnaud de Villeneuve, Centre Hospitalo-Universitaire de Montpellier, 371 Avenue du Doyen Gaston Giraud, 34000 Montpellier, France.

出版信息

AJR Am J Roentgenol. 2010 Mar;194(3):574-8. doi: 10.2214/AJR.08.2120.

DOI:10.2214/AJR.08.2120

PMID:20173130

Abstract

OBJECTIVE

The purpose of this study was to study the feasibility and diagnostic capability of preoperative cardiac CT for depicting aortic valvular pseudoaneurysms and vegetations in patients referred for aortic endocarditis requiring surgical intervention.

MATERIALS AND METHODS

Consecutive patients presenting with active aortic endocarditis requiring surgical intervention were included. CT scan examinations were performed for assessing coronary artery status. Aortic valves were retrospectively analyzed. Contrast-enhanced CT scans were retrospectively gated to the ECG and obtained without the administration of a beta-blocker. The CT and intraoperative findings were systematically compared.

RESULTS

During a 4-year period, 19 consecutive patients (18 men and one woman) were included (mean age +/- SD, 55 +/- 13 years). Results are expressed on a per-patient basis. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in depicting aortic valve pseudoaneurysms were 100%, 87.5%, 91.7%, and 100%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of the MDCT in depicting the extension of the aortic valve pseudoaneurysms into the intervalvular fibrous body were each 100%. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT in depicting aortic valve vegetations were 71.4%, 100%, 100%, and 55.5%, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of MDCT for depicting aortic valve vegetations larger than 1 cm were all 100%.

CONCLUSION

Our study shows the feasibility of preoperative CT in aortic infective endocarditis for providing relevant data about the presence and relationships of aortic valvular pseudoaneurysms. A larger prospective study including a systematic comparison with transesophageal echocardiography should be performed to determine the respective value of each technique.

摘要

目的

本研究旨在探讨术前心脏 CT 检查对主动脉瓣假性动脉瘤和赘生物的可行性和诊断能力，这些患者因主动脉瓣感染性心内膜炎需手术干预。

材料与方法

连续纳入有症状的主动脉瓣感染性心内膜炎患者，这些患者需手术干预。对 CT 扫描检查进行评估，以确定冠状动脉情况。回顾性分析主动脉瓣。回顾性门控对比增强 CT 扫描与心电图同步进行，未使用β受体阻滞剂。系统比较 CT 和术中发现。

结果

在 4 年期间，共纳入 19 例连续患者（18 例男性，1 例女性；平均年龄 55±13 岁）。结果按患者计算。MDCT 对主动脉瓣假性动脉瘤的敏感性、特异性、阳性预测值和阴性预测值分别为 100%、87.5%、91.7%和 100%。MDCT 对主动脉瓣假性动脉瘤延伸至瓣下纤维体的敏感性、特异性、阳性预测值和阴性预测值均为 100%。MDCT 对主动脉瓣赘生物的敏感性、特异性、阳性预测值和阴性预测值分别为 71.4%、100%、100%和 55.5%。MDCT 对大于 1cm 的主动脉瓣赘生物的敏感性、特异性、阳性预测值和阴性预测值均为 100%。