经食管超声心动图与心脏计算机断层扫描在感染性心内膜炎中的诊断性能。
Diagnostic Performance of Transesophageal Echocardiography and Cardiac Computed Tomography in Infective Endocarditis.
机构信息
Radiology Department, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Cardiology Department, SOS Endocardites unit, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France; INSERM U955, Team 8, Paris-Est Creteil University, Val-de-Marne, Créteil, France.
出版信息
J Am Soc Echocardiogr. 2020 Dec;33(12):1442-1453. doi: 10.1016/j.echo.2020.07.017. Epub 2020 Sep 25.
BACKGROUND
Multimodality imaging is essential for infective endocarditis (IE) diagnosis. The aim of this work was to evaluate the agreement between transesophageal echocardiography (TEE) and cardiac computed tomography (CT) findings in patients with surgically confirmed IE.
METHODS
Sixty-eight patients (mean age 63 ± 2 years) with a definite diagnosis of left-side IE according to the modified European Society of Cardiology Duke criteria, on both native and prosthetic valves, underwent TEE and cardiac CT before surgery. The presence of valvular (vegetations, erosion) and paravalvular (abscess, pseudoaneurysm) IE-related lesions were compared between both modalities. Perioperative inspection was used as reference.
RESULTS
TEE performed better than CT in detecting valvular IE-related lesions (TEE area under the curve [AUC] = 0.881 vs AUC = 0.720, P = .02) and was similar to CT with respect to paravalvular IE-related lesions (AUC = 0.830 vs AUC = 0.816, P = .835). The ability of TEE to detect vegetation was significantly better than that of CT (AUC = 0.863 vs AUC = 0.693, P = .02). The maximum size of vegetations was moderately correlated between modalities (Spearman's rho = 0.575, P < .001). Computed tomography exhibited higher sensitivity than TEE for pseudoaneurysm detection (100% vs 66.7%, respectively) but was similar with respect to diagnostic accuracy (AUC = 0.833 vs AUC = 0.984, P = .156).
CONCLUSIONS
In patients with a definite diagnosis of left-side IE according to the modified European Society of Cardiology Duke criteria, TEE performed better than CT for the detection of valvular IE-related lesions and similar to CT for the detection of paravalvular IE-related lesions.
背景
多模态影像学对于感染性心内膜炎（IE）的诊断至关重要。本研究旨在评估经胸超声心动图（TEE）与心脏计算机断层扫描（CT）在经手术证实的 IE 患者中的检查结果的一致性。
方法
68 例患者（平均年龄 63±2 岁）根据改良的欧洲心脏病学会（ESC）的 Duke 标准，在原生瓣膜和人工瓣膜上均被明确诊断为左侧 IE，术前均接受了 TEE 和心脏 CT 检查。比较两种方法对瓣膜（赘生物、侵蚀）和瓣周（脓肿、假性动脉瘤）IE 相关病变的检出情况。手术期间的检查作为参考。
结果
TEE 在检测瓣膜 IE 相关病变方面优于 CT（TEE 的曲线下面积[AUC]为 0.881，而 AUC 为 0.720，P=0.02），与 CT 相比，TEE 在检测瓣周 IE 相关病变方面也具有相似的表现（AUC 为 0.830，而 AUC 为 0.816，P=0.835）。TEE 检测赘生物的能力明显优于 CT（AUC 为 0.863，而 AUC 为 0.693，P=0.02）。两种方法检测的赘生物最大尺寸之间存在中度相关性（Spearman 相关系数为 0.575，P<0.001）。CT 对假性动脉瘤的检测敏感性高于 TEE（分别为 100%和 66.7%），但在诊断准确性方面相似（AUC 为 0.833 和 AUC 为 0.984，P=0.156）。
结论
对于根据改良的 ESC Duke 标准明确诊断为左侧 IE 的患者，TEE 检测瓣膜 IE 相关病变的效果优于 CT，而 CT 检测瓣周 IE 相关病变的效果与 TEE 相似。
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