From the Division of Cardiology, Severance Cardiovascular Hospital (I.-C.K., G.-R.H., J.-W.H., C.Y.S.), Department of Cardiovascular Surgery, Severance Cardiovascular Hospital (S.H.L., S.L., B.-C.C.), and Department of Radiology, Research Institute of Radiological Science, Severance Hospital (S.C., Y.J.K.), Yonsei University College of Medicine; and Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University (I.-C.K.).
Circ Cardiovasc Imaging. 2018 Mar;11(3):e006986. doi: 10.1161/CIRCIMAGING.117.006986.
Recent evolution of cardiac computed tomography (CT) provides useful information about valvular and perivalvular structures. We compared the diagnostic performance of CT and transesophageal echocardiography (TEE) with applications of 3-dimensional reconstruction in detecting vegetation and intracardiac complications in patients with infective endocarditis (IE).
Seventy-five patients (53 men; age, 58±15 years) with definite IE who underwent TEE and CT with 3-dimensional reconstruction within 3 days were analyzed. The diagnostic performances of the 2 modalities for vegetation and IE-related intracardiac complications (valve perforation, valve aneurysm, perivalvular abscess, pseudoaneurysm, fistula, and prosthetic valve dehiscence) were compared. The detection rate of vegetation in TEE and CT was 97.3% and 72.0%, respectively. The maximum sizes of vegetation identified by TEE and CT were well correlated (=0.593; <0.001), especially in patients with large vegetation (≥10 mm), suggestive of a high risk of systemic embolism (=0.608; <0.001). However, small vegetation (<10 mm) was underdiagnosed by CT (52.8%) compared with TEE (94.4%), and the sizes of the 2 modalities were poorly correlated (=0.187; =0.445). Both modalities showed fair diagnostic performance for detecting IE-related intracardiac complications with excellent agreement. TEE was more useful for diagnosing valve perforation and intracardiac fistula, whereas CT was better for diagnosing perivalvular abscess.
Cardiac CT shows a comparable diagnostic performance with TEE for large vegetation and several IE-related complications. TEE is better for detecting small vegetation, valve perforation, and intracardiac fistula, whereas CT is more useful for detecting perivalvular abscess and coronary artery disease.
心脏计算机断层扫描（CT）的最新发展为瓣叶和瓣周结构提供了有用的信息。我们比较了 CT 和经食管超声心动图（TEE）在三维重建应用下对感染性心内膜炎（IE）患者的赘生物和心内并发症的诊断性能。
分析了 75 例（53 例男性；年龄 58±15 岁）在 3 天内接受 TEE 和 CT 三维重建的明确 IE 患者。比较了两种方法对赘生物和 IE 相关心内并发症（瓣叶穿孔、瓣叶动脉瘤、瓣周脓肿、假性动脉瘤、瘘管和人工瓣膜裂开）的诊断性能。TEE 和 CT 对赘生物的检出率分别为 97.3%和 72.0%。TEE 和 CT 识别的赘生物最大尺寸具有良好的相关性（=0.593；<0.001），尤其是在有大赘生物（≥10mm）的患者中，提示有较高的全身栓塞风险（=0.608；<0.001）。然而，与 TEE（94.4%）相比，CT 对小赘生物（<10mm）的诊断率较低（52.8%），且两种方法的尺寸相关性较差（=0.187；=0.445）。两种方法对 IE 相关心内并发症的诊断性能均较好，一致性很高。TEE 更有助于诊断瓣叶穿孔和心内瘘，而 CT 更有助于诊断瓣周脓肿。
心脏 CT 与 TEE 对大赘生物和几种 IE 相关并发症的诊断性能相当。TEE 更有助于发现小赘生物、瓣叶穿孔和心内瘘，而 CT 更有助于发现瓣周脓肿和冠状动脉疾病。
