Low R N, Wall S D, Jeffrey R B, Sollitto R A, Reilly L M, Tierney L M
Department of Radiology, University of California, San Francisco 94143.
Radiology. 1990 Apr;175(1):157-62. doi: 10.1148/radiology.175.1.2315475.
A blinded retrospective study was performed to determine the sensitivity and specificity of computed tomography (CT) in detecting perigraft infection (PGI) and aortoenteric fistula (AEF), rare but devastating complications of aortic reconstructive surgery. Two observers independently reviewed CT scans in 55 cases including AEF (n = 23); PGI (n = 12); and normal, noninfected grafts (n = 20). Each scan was assessed for ectopic gas, focal bowel wall thickening, perigraft fluid, perigraft soft tissue, pseudoaneurysm formation, disruption of the aneurysmal wrap, and increased soft tissue between the graft and surrounding wrap. Comparison of CT findings with operative results revealed that each observer correctly identified as abnormal 33 of 35 cases of PGI either with or without AEF (sensitivity, 94%) and that results were falsely positive in three cases (specificity, 85%). CT findings ranged from large amounts of perigraft soft tissue and ectopic gas to subtle findings of minimal or no abnormalities; thus, strict criteria must be applied to the interpretation of CT scans after aortic surgery. Although CT is not 100% sensitive or specific, the authors conclude that it will continue to be valuable for diagnosing PGI and AEF.
进行了一项盲法回顾性研究，以确定计算机断层扫描（CT）在检测移植物周围感染（PGI）和主动脉肠瘘（AEF）方面的敏感性和特异性，这是主动脉重建手术中罕见但极具破坏性的并发症。两名观察者独立审查了55例患者的CT扫描结果，其中包括AEF（n = 23）；PGI（n = 12）；以及正常、未感染的移植物（n = 20）。对每次扫描评估是否存在异位气体、局限性肠壁增厚、移植物周围积液、移植物周围软组织、假性动脉瘤形成、动脉瘤包裹破裂以及移植物与周围包裹物之间软组织增加。将CT检查结果与手术结果进行比较，发现每位观察者正确识别出35例PGI患者中的33例，无论是否合并AEF（敏感性为94%），有3例假阳性结果（特异性为85%）。CT检查结果从大量移植物周围软组织和异位气体到微小或无异常的细微表现不等；因此，对主动脉手术后CT扫描的解读必须应用严格的标准。尽管CT并非100%敏感或特异，但作者得出结论，它在诊断PGI和AEF方面仍将具有重要价值。
