From the Departments of Radiology (W.Y., G.R., X.Z., L.W., H.L.), Cardiovascular Surgery (X.J.), and Adult Echocardiography (O.C., Q.M., H.F., Q.L.), Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Guangzhou, Guangdong, P. R. China 510080.
Radiology. 2020 Nov;297(2):334-341. doi: 10.1148/radiol.2020200685. Epub 2020 Sep 1.
Background The 2015 European Society of Cardiology guidelines acknowledged similar diagnostic performance of electrocardiography (ECG)-gated CT on perivalvular abscesses compared with transesophageal echocardiography (TEE), but data on ECG-gated CT remain insufficient. Purpose To determine the diagnostic performance of ECG-gated CT for assessing aortic root perivalvular abscesses and to compare it with TEE. Materials and Methods Between January 2008 and June 2019, the imaging records of surgically confirmed infective endocarditis were retrospectively reviewed for presence of aortic perivalvular abscesses, their extension, fistulization, vegetations, and valvular destruction. The diagnostic performance of ECG-gated CT was analyzed in all patients (part A) and in an noninferiority analysis (part B; δ = -10%) in patients undergoing TEE. Results A total of 178 patients (median age, 54 years [interquartile range, 15 years]; 147 men) were evaluated (CT, = 178; TEE, = 35). In part A, the sensitivity and specificity of CT were 70 of 71 (99% [95% confidence interval (CI): 96%, 100%]) and 102 of 107 (95% [95% CI: 91%, 99%]) for abscess; 65 of 68 (96% [95% CI: 91%, 100%]) and 107 of 110 (97% [95% CI: 94%, 100%]) for extension, 36 of 36 (100% [95% CI: 100%, 100%]) and 139 of 142 (98% [95% CI: 96%, 100%]) for fistulization, 153 of 160 (96% [95% CI: 93%, 99%]) and five of 18 (28% [95% CI: 7%, 49%]) for vegetations, and 90 of 90 (100% [95% CI: 100%, 100%]) and 24 of 88 (27% [95% CI: 18%, 37%]) for valvular destruction. In part B, ECG-gated CT had noninferior sensitivity compared with TEE for detecting abscess (difference, 14 percentage points [lower one-sided 95% CI: -4 percentage points]), extension (difference, 0 percentage points [lower one-sided 95% CI: 0 percentage points]), fistulization (difference, 0 percentage points [lower one-sided 95% CI: 0 percentage points]), and valvular destruction (difference, 5 percentage points [lower one-sided 95% CI: -4 percentage points]). Specificity of CT was inferior for demonstrating perivalvular abscess (difference, 5 percentage points [lower one-sided 95% CI: -11 percentage points]) and valvular destruction (difference, -62 percentage points [lower one-sided 95% CI: -92 percentage points]). ECG-gated CT had inferior sensitivity in detecting vegetations (difference, -6 percentage points [lower one-sided 95% CI: -14 percentage points]). Conclusion Electrocardiography-gated CT had noninferior sensitivity compared with transesophageal echocardiography for identification of aortic perivalvular abscesses, extension of these abscesses, fistulization, and valvular destruction but had inferior sensitivity in detection of vegetations. © RSNA, 2020 See also the editorial by Sakuma in this issue.
背景 2015 年欧洲心脏病学会指南承认心电图门控 CT 在诊断瓣周脓肿方面与经食管超声心动图（TEE）具有相似的诊断性能，但心电图门控 CT 的数据仍然不足。目的 确定心电图门控 CT 诊断主动脉瓣周脓肿的性能，并与 TEE 进行比较。 材料与方法 回顾性分析 2008 年 1 月至 2019 年 6 月手术确诊感染性心内膜炎患者的影像学记录，以评估主动脉瓣周脓肿的存在、其延伸、瘘管形成、赘生物和瓣叶破坏。在所有患者中（A 部分）和在 TEE 检查患者中（B 部分，δ=-10%）进行了心电图门控 CT 的诊断性能分析。 结果 共评估了 178 例患者（中位数年龄 54 岁[四分位距 15 岁]；147 例男性）（CT： = 178；TEE： = 35）。在 A 部分，CT 对脓肿的敏感性和特异性分别为 71 例中的 70 例（99%[95%置信区间：96%，100%]）和 107 例中的 102 例（95%[95%置信区间：91%，99%]）；68 例中的 65 例（96%[95%置信区间：91%，100%]）和 110 例中的 107 例（97%[95%置信区间：94%，100%]）；36 例中的 36 例（100%[95%置信区间：100%，100%]）和 142 例中的 139 例（98%[95%置信区间：96%，100%]）；160 例中的 153 例（96%[95%置信区间：93%，99%]）和 18 例中的 5 例（28%[95%置信区间：7%，49%]）；90 例中的 90 例（100%[95%置信区间：100%，100%]）和 88 例中的 24 例（27%[95%置信区间：18%，37%]）。在 B 部分，心电图门控 CT 在检测脓肿方面的敏感性与 TEE 相比无差异（差异，14 个百分点[下单侧 95%置信区间：-4 个百分点]）、延伸（差异，0 个百分点[下单侧 95%置信区间：0 个百分点]）、瘘管形成（差异，0 个百分点[下单侧 95%置信区间：0 个百分点]）和瓣叶破坏（差异，5 个百分点[下单侧 95%置信区间：-4 个百分点]）。CT 显示瓣周脓肿（差异，5 个百分点[下单侧 95%置信区间：-11 个百分点]）和瓣叶破坏（差异，-62 个百分点[下单侧 95%置信区间：-92 个百分点]）的特异性较低。心电图门控 CT 检测赘生物的敏感性较低（差异，-6 个百分点[下单侧 95%置信区间：-14 个百分点]）。 结论 与 TEE 相比，心电图门控 CT 诊断主动脉瓣周脓肿、脓肿延伸、瘘管形成和瓣叶破坏的敏感性无差异，但在检测赘生物方面敏感性较低。
