CT血管成像在腹主动脉移植物感染中的诊断价值  

Diagnostic value of CT angiography in abdominal aortic graft infection

作　　者：彭明亮 刘浩 程赛明 杨呈伟 黄连军 PENG Mingliang;LIU Hao;CHENG Saiming;YANG Chengwei;HUANG Lianjun(Department of Interventional Therapy,Deltahealth Hospital ShangHai,Shanghai 201702,China)

机构地区：[1]上海德达医院介入治疗科,201702

出　　处：《心肺血管病杂志》2023年第9期952-957,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨CT血管成像(CT angiography,CTA)在腹主动脉移植物感染中的诊断价值。方法:收集2019年9月至2022年3月,在本院诊断的12例腹主动脉移植物感染患者的临床及影像资料,总结分析腹主动脉移植物感染的临床特征及CTA的影像表现等。结果:11例男性,1例女性,中位年龄57(51,70)岁,腔内修复术后支架感染9例,主动脉人工血管感染3例,术前CTA确诊为感染性动脉瘤6例,其中1例合并主动脉肠瘘,术后至确诊移植物感染的间隔中位时间为1(0.75~10)个月;术前CTA确诊为非感染性动脉瘤6例,术后至确诊移植物感染的间隔中位时间为36(1~156)个月,感染性动脉瘤移植物感染的发病时明显短于非感染性动脉瘤的时间(P<0.05),血培养或脓液培养阳性9例(75%),CTA影像表现为移植物周围血管壁外不规则渗出影和(或)移植物周围少许气泡影9例;移植物周围不规则动脉瘤伴周围模糊渗出3例。10例患者术前做了正电子发射断层显像CT(PET-CT)检查,与CTA确定的是否存在移植物感染及感染范围、程度均高度一致。结论:CTA能直观显示腹主动脉移植物感染的征象及明确感染的范围,是腹主动脉移植物感染临床评价的首选影像检查方法,感染性动脉瘤的腔内治疗要慎重选择且需要更加规范。Objective:To investigate the diagnostic value of CT angiography(CTA)in abdominal aortic graft infection.Methods:The clinical and imaging data of 12 patients with abdominal aortic graft infection diagnosed in our hospital from September 2019 to March 2022 were collected,and the clinical characteristics of abdominal aortic graft infection and the imaging manifestations of CTA were summarized and analyzed.Results:11 cases were male,1 case was female,the median age was 57 years old(51-70 years old),9 cases were stent infection after endovascular repair,3 cases were aortic artificial vessel infection,6 cases were diagnosed as infectious aneurysm by CTA before operation,1 case was associated with aortic intestinal fistula,and the median interval from the operation to the diagnosis of graft infection was 1 month(0.75-10 months);There were 6 cases of noninfectious aneurysms diagnosed by CTA before operation,and the median interval from the operation to the diagnosis of graft infection was 36 months(1-156 months).The onset of graft infection of infectious aneurysms was significantly shorter than that of noninfectious aneurysms(P<0.05).Blood culture or pus culture was positive in 9 cases(75%).CTA imaging showed irregular extravascular exudation around the graft and/or a few bubbles around the graft in 9 cases;Ambiguous exudation around the graft accompanied by the formation of peripheral pseudoaneurysm was found in 3 cases.PET-CT examination was performed in 10 patients before operation,which was basically consistent with CTA's determination of whether there was graft infection and the extent and degree of infection.Conclusions:CTA can directly display the signs of abdominal aortic graft infection and define the scope of infection.CTA is the first imaging examination method for clinical evaluation of abdominal aortic graft infection.Endovascular treatment of infectious aneurysm should be carefully selected and more standardized.

关 键 词：移植物感染 主动脉腔内修复术 CT血管成像 

分 类 号：R54[医药卫生—心血管疾病]