Institute and Policlinic for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany.
Department of Nuclear Medicine, University Hospital, Carl Gustav Carus University, TU Dresden, Germany.
Rofo. 2022 Nov;194(11):1250-1257. doi: 10.1055/a-1830-7412. Epub 2022 Jun 8.
In critically ill ICU patients, initial results showed that opposite enhancement of the adrenal glands (↑) and spleen (↓) on portal venous CT scans was associated with increased mortality over the next days to a month, with short-term mortality being best predicted. The study aimed to validate the adrenal-to-spleen ratio determined in a pilot study concerning mortality prediction.
371 portal venous CT scans of 203 ICU patients (127 men, age: 68.1 ± 14.4 years) were included in the retrospective analysis. Region-of-interest (ROI)-based Hounsfield units of the adrenal glands and the spleen and their density ratio were evaluated. The Matthews correlation coefficient (MCC) and ROC analysis were used to establish a threshold for the adrenal-to-spleen ratio regarding mortality within 72 hours of imaging. The quality of the classification of survivors and deceased patients in the current collective based on the threshold determined in a pilot study and on the current threshold was determined. The precision-recall curve (PRC) was used to test the influence of the addition of patients with low vital risk on the ROC.
The current threshold of 1.37 for the adrenal-to-spleen ratio provides good discriminatory power between those who died and those who survived (MCC: 0.87; sensitivity: 83.7 %; specificity: 99.1 %; PPV: 93.2 %; NPV: 97.6 %) and differs only slightly from the threshold of 1.41 determined in the pilot study, which consequently has comparable discriminatory power.
As a reproducible image-based prognostic marker, the portal venous adrenal-to-spleen ratio has a high predictive power for short-term death in ICU patients. It is, therefore, suitable as an indicator of high risk of death within 72 hours after imaging.
· In cases of shock, CT perfusion changes of the abdominal organs can be observed.. · These changes are summarized under the term CT hypoperfusion complex.. · Organ enhancement ratios allow conclusions about the patient's short-term survival.. · The portal venous adrenal-to-spleen ratio is a sufficient prognostic mortality parameter..
· Winzer R, Hoffmann R, Fedders D. The Portal-Venous Enhancement Ratio of the Adrenal Glands and Spleen as a Short-Term Predictor of Mortality in Intensive Care Patients. Fortschr Röntgenstr 2022; 194: 1250 - 1257.
在重症监护病房（ICU）的危重病患者中，最初的研究结果表明，门静脉 CT 扫描上肾上腺（↑）和脾脏（↓）的相反增强与接下来几天到一个月内的死亡率增加有关，并且短期死亡率的预测效果最佳。本研究旨在验证一项关于死亡率预测的试点研究中确定的肾上腺-脾脏比值。
回顾性分析了 203 例 ICU 患者（男 127 例，年龄：68.1±14.4 岁）的 371 例门静脉 CT 扫描。使用基于感兴趣区域（ROI）的方法评估肾上腺和脾脏的亨氏单位值及其密度比。使用 Matthews 相关系数（MCC）和 ROC 分析确定在影像学检查后 72 小时内预测死亡率的肾上腺-脾脏比值的阈值。根据试点研究和当前阈值确定的分类标准，确定当前存活和死亡患者的分类质量。使用精确-召回曲线（PRC）来测试将低生命风险患者纳入 ROC 对 ROC 的影响。
当前肾上腺-脾脏比值的阈值为 1.37，可在死亡和存活患者之间提供良好的区分能力（MCC：0.87；敏感性：83.7％；特异性：99.1％；PPV：93.2％；NPV：97.6％），并且仅略低于在试点研究中确定的阈值 1.41，这表明两者具有相当的区分能力。
作为一种可重复的基于图像的预后标志物，门静脉肾上腺-脾脏比值对 ICU 患者的短期死亡具有很高的预测能力。因此，它适用于在影像学检查后 72 小时内作为死亡风险高的指标。
·在休克情况下，可观察到腹部器官的 CT 灌注变化。·这些变化在 CT 低灌注综合征下进行总结。·器官增强比值可得出患者短期生存的结论。·门静脉肾上腺-脾脏比值是一种充分的预后死亡率参数。
