Department of Radiology, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France.
Department of Medical Intensive Care, University Hospital, 3 Boulevard Fleming, 25030, Besançon, France.
Eur Radiol. 2019 Jul;29(7):3839-3846. doi: 10.1007/s00330-018-5994-x. Epub 2019 Feb 8.
The aims of the present work were to reevaluate, prospectively, the diagnostic value of already-described computed tomography (CT) landmarks of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) and to study the diagnostic value of some undescribed CT signs for the diagnosis of IAH and ACS.
Consecutive patients admitted to the intensive care unit (ICU) in shock for whom an abdominal CT was clinically indicated were included. CT examinations were reviewed and scored by two reviewers for the 12 proposed CT features of IAH and ACS. Intravesical pressure (IVP) was measured for each patient. Imaging features and clinical data of patients with IAH (IVP ≥ 12 mmHg) were compared to those of patients with normal intra-abdominal pressure (IVP < 12 mmHg).
Forty-one patients were included. Twenty-one patients (51%) presented IAH with an IVP value ≥ 12 mmHg. Four patients (10%) were considered to have ACS (10%). Only an increased peritoneal-to-abdominal height ratio (PAR) was associated with the presence of IAH (PAR = 0.45 [0.40-0.49] in patients with IVP < 12 mmHg and PAR = 0.52 [0.48-0.53] in patients with IVP ≥ 12 mmHg; p < 0.001). Increased PAR ≥ 0.52 had a specificity of 85% for IAH diagnosis.
The present study suggests that a PAR ≥ 0.52 could help radiologists to identify IAH on abdominal CT scan and could lead to adequate identification and/or treatment, even at early stages of IAH.
• CT is an efficient first-intention procedure to evaluate and follow up underlying conditions in critically ill patients at risk of IAH and ACS overcome. • Raising the possibility of an IAH on a CT examination is relevant information for the clinician. • The only factors associated with intra-abdominal hypertension were the peritoneal-to-abdominal height ratio (PAR) and the ratio of maximal anteroposterior to transverse abdominal diameter (which define the round belly sign when > 0.8).
本研究旨在重新评估已描述的计算机断层扫描（CT）腹部内高压（IAH）和腹腔间隔室综合征（ACS）的诊断价值，并研究一些未描述的 CT 征象对 IAH 和 ACS 诊断的价值。
连续纳入因休克而收入重症监护病房（ICU）并需要进行腹部 CT 检查的患者。由两名观察者对 12 项 IAH 和 ACS 的 CT 特征进行回顾性评分。对每位患者进行膀胱内压（IVP）测量。比较 IAH 患者（IVP≥12mmHg）和正常腹腔内压患者（IVP<12mmHg）的影像学特征和临床资料。
共纳入 41 例患者。21 例（51%）患者存在 IAH，IVP 值≥12mmHg。4 例（10%）患者被认为患有 ACS（10%）。仅腹膜腹腔比（PAR）增加与 IAH 的存在相关（IVP<12mmHg 的患者 PAR=0.45[0.40-0.49]，IVP≥12mmHg 的患者 PAR=0.52[0.48-0.53]；p<0.001）。PAR≥0.52 对 IAH 的诊断具有 85%的特异性。
本研究表明，PAR≥0.52 可帮助放射科医生在腹部 CT 扫描中识别 IAH，并可导致在 IAH 的早期阶段进行充分的识别和/或治疗。
CT 是评估和随访存在 IAH 和 ACS 风险的危重症患者潜在疾病的一种有效的一线方法。
在 CT 检查中提出 IAH 的可能性是临床医生的重要信息。
与 IAH 相关的唯一因素是腹膜腹腔比（PAR）和最大前后径与横径比（当>0.8 时定义为圆形腹部征）。
