Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, India.
Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore, India.
Am J Trop Med Hyg. 2018 Oct;99(4):852-857. doi: 10.4269/ajtmh.18-0395.
Among pyogenic liver abscesses, melioid etiology is considered in endemic regions in the presence of known health or occupational risk factors. "Honeycomb sign," used to describe an abscess with multiple internal septations dividing the abscess cavity into multiple loculations of comparable sizes on imaging, is a sensitive sign for melioid liver abscess. This is a retrospective case-control study investigating incidence, sensitivity, and specificity of "honeycomb sign" in melioid liver abscess, in a cohort of patients with culture-proven melioidosis infection. Abscesses ≥ 2 cm were analyzed for the honeycomb sign. value < 0.05 was taken as statistically significant. Interobserver agreement was calculated between two radiologists for the presence of the sign, sensitivity, and specificity. A total of 40 abscesses were analyzed. Thirty-four abscesses (85%) manifested the honeycomb sign with interobserver agreement (kappa = 0.70 and 0.92). Sensitivity of the sign is 85% (95% confidence interval [CI]: 70-94%), specificity is 75% (95% CI: 59-87%), positive predictive value is 77% (95% CI: 62-88%), and negative predictive value is 83% (95% CI: 67-94%). If abscess size is ≥ 3 cm, the sensitivity is 91% (95% CI: 77-98%), specificity is 75% (95% CI: 59-87%), positive predictive value is 76% (95% CI: 61-88%), and negative predictive value is 91% (95% CI: 76-98%). Honeycomb sign is a novel imaging marker for melioid liver abscess. Increased awareness and recognition of this imaging feature has the potential to affect patient management.
在存在已知健康或职业风险因素的流行地区，对于化脓性肝脓肿，应考虑类鼻疽病因。“蜂窝征”用于描述在影像学上具有多个内部分隔的脓肿，将脓肿腔分为多个大小相当的分隔腔。这是一种用于诊断类鼻疽肝脓肿的敏感征象。本研究为回顾性病例对照研究，旨在调查“蜂窝征”在经培养证实的类鼻疽感染患者中的类鼻疽肝脓肿的发生率、敏感性和特异性。分析脓肿直径≥2cm 的“蜂窝征”。以P 值＜0.05 为有统计学意义。两位放射科医生评估该征象的存在、敏感性和特异性，并计算观察者间的一致性。共分析了 40 个脓肿。34 个脓肿（85%）表现出蜂窝征，观察者间的一致性（kappa=0.70 和 0.92）。该征象的敏感性为 85%（95%可信区间：70-94%），特异性为 75%（95%可信区间：59-87%），阳性预测值为 77%（95%可信区间：62-88%），阴性预测值为 83%（95%可信区间：67-94%）。如果脓肿直径≥3cm，敏感性为 91%（95%可信区间：77-98%），特异性为 75%（95%可信区间：59-87%），阳性预测值为 76%（95%可信区间：61-88%），阴性预测值为 91%（95%可信区间：76-98%）。蜂窝征是类鼻疽肝脓肿的一种新的影像学标志物。提高对这一影像学特征的认识和认识，有可能影响患者的管理。
