Boos Johannes, Schek Julia, Kröpil Patric, Heusch Philipp, Heinzler Niklas, Antoch Gerald, Lanzman Rotem Shlomo
Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, Moorenstrasse 5, 40225, Dusseldorf, Germany.
Radiologie, MVZ am RKK, Bremen, Germany.
Can Assoc Radiol J. 2017 Feb;68(1):21-26. doi: 10.1016/j.carj.2016.07.006. Epub 2016 Dec 20.
The study sought to assess the frequency and prognostic value of hyperattenuating adrenal glands on contrast-enhanced computed tomography (CT) scans of surgical intensive care unit (ICU) patients with acute clinical deterioration.
Eighty-eight consecutive ICU patients (63.2 ± 14.5 years of age) were included in this retrospective analysis. All patients underwent biphasic contrast-enhanced CT due to an acute clinical deterioration. Hyperattenuation of the adrenal glands was assessed subjectively and objectively. Subjective presence or absence of hyperattenuating adrenal glands was assessed by 2 blinded radiologists (J.B. and R.S.L.) in consensus. Hounsfield units (HU) were measured in the adrenal glands and in the inferior vena cava. Objective hyperattenuation was defined as HU (adrenal glands) > HU (inferior vena cava) with a 15-HU threshold. Death within 14 days following CT was set as endpoint and acquired from electronic patient data.
Thirty-eight patients (43.2%, Group A) exhibited hyperattenuation of the adrenal glands, whereas 50 patients (56.8%, Group B) did not. Concerning the objective analysis, 31 patients (35.2%, Group A) exhibited hyperdense adrenal glands, whereas 53 patients (64.8%, Group B) did not. Overall 27 of 88 patients (30.6%) died within 14 days following the CT examination. Lethal outcome was significantly more frequent among patients in Group A and A (19 of 38 patients [50.0%] and 15 of 31 patients [48.4%]) as compared with patients in Group B (8 of 50 patients [16.0%]) and Group B (12 of 57 patients [21.1%]; P < .05). Subjective and objective analysis correlated significantly (P < .05).
Hyperattenuation of adrenal glands on contrast-enhanced CT of ICU patients with acute clinical deterioration is associated with a high mortality and might serve as a prognostic marker for patients' outcome.
本研究旨在评估在外科重症监护病房（ICU）中出现急性临床恶化的患者，其肾上腺在对比增强计算机断层扫描（CT）上出现高密度影的频率及预后价值。
本回顾性分析纳入了88例连续的ICU患者（年龄63.2±14.5岁）。所有患者因急性临床恶化均接受了双期对比增强CT检查。对肾上腺的高密度影进行主观和客观评估。由2名不知情的放射科医生（J.B.和R.S.L.）共同主观评估肾上腺高密度影的有无。在肾上腺及下腔静脉测量亨氏单位（HU）。客观高密度影定义为肾上腺的HU值大于下腔静脉的HU值，阈值为15 HU。将CT检查后14天内的死亡情况设为终点，并从电子患者数据中获取。
38例患者（43.2%，A组）肾上腺出现高密度影，而50例患者（56.8%，B组）未出现。客观分析显示，31例患者（35.2%，A组）肾上腺呈高密度，而53例患者（64.8%，B组）未出现。总体而言，88例患者中有27例（30.6%）在CT检查后14天内死亡。与B组（50例患者中的8例[16.0%]）和B组（57例患者中的12例[21.1%]）相比，A组和A组患者的致死率明显更高（38例患者中的19例[50.0%]和31例患者中的15例[48.4%]；P<0.05）。主观和客观分析具有显著相关性（P<0.05）。
在外科重症监护病房中出现急性临床恶化的患者，其肾上腺在对比增强CT上出现高密度影与高死亡率相关，可能作为患者预后的一个预测指标。
