Department of General Medicine, Shirakawa Satellite for Teaching and Research (STAR), Fukushima Medical University, Shirakawa City, Fukushima, Japan.
Graduate School of Medicine, Fukushima Medical University. Fukushima City, Fukushima, Japan.
Acta Radiol. 2022 Feb;63(2):268-277. doi: 10.1177/0284185120988817. Epub 2021 Jan 28.
In older adults, the diagnosis of acute pyelonephritis is challenging because of non-specific symptoms and false-positive urine test results. Few studies have investigated the diagnostic performance of computed tomography (CT) signs.
To evaluate the diagnostic performance of CT signs for acute pyelonephritis in older patients suspected of infection with unknown focus.
This cross-sectional study was conducted between 2015 and 2018. Patients aged ≥65 years who underwent blood cultures, urine culture, and non-contrast or contrast-enhanced CT on admission were included. Cases with clinically presumable infection focus before CT were excluded. Two radiologists blinded to clinical information independently reviewed five CT signs: perirenal fat stranding; pelvicalyceal wall thickening and enhancement; renal enlargement; thickening of Gerota's fascia; and area(s) of decreased attenuation. The final diagnoses were made by a clinical expert panel.
Among 473 eligible patients, 61 were diagnosed with acute pyelonephritis. When the laterality of findings between the left and right kidneys were considered, the positive and negative likelihood ratios of perirenal fat stranding were 4.0 (95% confidence interval [CI] = 2.3-7.0) and 0.8 (95% CI = 0.7-0.9) in non-contrast CT, respectively. The other signs in non-contrast CT showed similar diagnostic performance with positive and negative likelihood ratios of 3.5-11.3 and 0.8-0.9, respectively.
CT signs can help physicians diagnose acute pyelonephritis in older patients suspected of infection with unknown focus.
老年人急性肾盂肾炎的诊断具有挑战性，因为其症状不具有特异性且尿液检测结果可能出现假阳性。目前，很少有研究调查过 CT 征象的诊断性能。
评估 CT 征象在怀疑感染灶不明的老年患者中诊断急性肾盂肾炎的性能。
本横断面研究于 2015 年至 2018 年进行。纳入入院时接受血培养、尿培养和非增强或增强 CT 的年龄≥65 岁患者。排除 CT 前临床推测有感染灶的病例。两名放射科医生在不了解临床信息的情况下独立评估 5 种 CT 征象：肾周脂肪条索征、肾盂肾盏壁增厚和强化、肾脏增大、肾筋膜增厚和（或）局灶性密度减低。最终诊断由临床专家小组确定。
在 473 例符合条件的患者中，61 例被诊断为急性肾盂肾炎。当考虑左右肾脏之间发现的偏侧性时，非增强 CT 中肾周脂肪条索征的阳性和阴性似然比分别为 4.0（95%置信区间 [CI]：2.3-7.0）和 0.8（95%CI：0.7-0.9）。非增强 CT 中其他征象也具有类似的诊断性能，阳性和阴性似然比分别为 3.5-11.3 和 0.8-0.9。
CT 征象有助于医师诊断怀疑感染灶不明的老年患者的急性肾盂肾炎。
