Infected aortic aneurysms: Imaging findings
Infected aortic aneurysms: Imaging findings
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DOI：
10.1148/radiol.2311021700
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发表时间：
2004-04-01
期刊：
影响因子：
19.7
通讯作者：
Tie, ML
中科院分区：
文献类型：
--
作者：
Macedo, TA;Stanson, AW;Tie, ML
目的：探讨感染主动脉瘤的影像学特征。材料和方法：回顾25年来获得的感染主动脉瘤手术和/或微生物学证明的患者记录，发现29例患者中有31例动脉瘤。本研究包括21名男性和8名女性（平均年龄70岁）。一名放射科医生回顾了28项CT研究（22例患者进行了一次CT检查，3例患者进行了两次CT检查），12项动脉造影（12例患者进行了一次动脉造影），8项核医学研究（6例患者进行了一次核医学成像，1例患者进行了两次核医学成像），3项磁共振（MR）研究（3例患者进行了一次MR成像）。评估的特征包括动脉瘤的大小、形状和位置；分支机构参与;主动脉壁钙化；气体;放射性示踪剂在核医学研究中的应用以及主动脉周围和相关的发现。将感染的主动脉瘤与动脉硬化性动脉瘤的位置进行比较。结果：动脉瘤位于升主动脉（n = 2, 6%）、胸降主动脉（n = 7, 23%）、胸腹主动脉（n = 6, 19%）、内脏旁主动脉（n = 2, 6%）、肾旁主动脉（n = 3, 10%）、肾下主动脉（n = 10, 32%）、肾动脉（n = 1, 3%）。两名患者有两个感染的主动脉瘤。CT示25个囊状动脉瘤（93%）和2个梭状动脉瘤（7%），初发现时平均直径5.4 cm（范围1-11 cm）。在序贯研究中，27例动脉瘤中有13例（48%）出现主动脉旁软组织肿块、搁浅和/或积液，3例（100%）患者出现动脉瘤快速进展和发展的早期主动脉周围水肿。其他表现包括邻近椎体破坏伴腰肌脓肿（n = 1.4%）、肾梗死（n = 1.4%）、主动脉壁无钙化（n = 2.7%）和主动脉周围气体（n = 2.7%）。血管造影显示13个囊状动脉瘤，其中10个（77%）呈分叶状轮廓。核医学成像显示7个动脉瘤中6个（86%）的活动性增加与感染一致。磁共振成像显示三个囊状动脉瘤。3例患者中有1例（33%）出现相邻异常椎体骨髓信号强度。结论：囊状动脉瘤（尤其是具有分叶状轮廓的动脉瘤）迅速扩张或发展，并在异常位置出现邻近肿块、搁浅和/或液体，是高度可疑的感染动脉瘤。(c) rsna， 2004年。
PURPOSE: To determine the imaging characteristics of infected aortic aneurysms.MATERIALS AND METHODS: Review of records of patients with surgical and/or microbiologic proof of infected aortic aneurysm obtained over a 25-year period revealed 31 aneurysms in 29 patients. This study included 21 men and eight women (mean age, 70 years). One radiologist reviewed 28 computed tomographic (CT) studies (22 patients underwent CT once and three patients underwent CT twice), 12 arteriograms (12 patients underwent arteriography once), eight nuclear medicine studies (six patients underwent nuclear medicine imaging once and one patient underwent nuclear medicine imaging twice), and three magnetic resonance (MR) studies (three patients underwent MR imaging once). Features evaluated included aneurysm size, shape, and location; branch involvement; aortic wall calcification; gas; radiotracer uptake on nuclear medicine studies; and periaortic and associated findings. The location of infected aortic aneurysms was compared with that of arteriosclerotic aneurysms.RESULTS: Aneurysms were located in the ascending aorta (n = 2, 6%), descending thoracic aorta (n = 7, 23%), thoracoabdominal aorta (n = 6, 19%), paravisceral aorta (n = 2, 6%), juxtarenal aorta (n = 3, 10%), infrarenal aorta (n = 10, 32%), and renal artery (n = 1, 3%). Two patients had two infected aortic aneurysms. CT revealed 25 saccular (93%) and two fusiform (7%) aneurysms with a mean diameter at initial discovery of 5.4 cm (range, 1-11 cm). Paraaortic soft-tissue mass, stranding, and/or fluid was present in 13 (48%) of 27 aneurysms, and early periaortic edema with rapid aneurysm progression and development was present in three (100%) patients with sequential studies. Other findings included adjacent vertebral body destruction with psoas muscle abscess (n = 1, 4%), kidney infarct (n = 1, 4%), absence of calcification in the aortic wall (n = 2, 7%), and periaortic gas (n = 2, 7%). Angiography showed 13 saccular aneurysms with lobulated contour in 10 (77%). Nuclear medicine imaging showed increased activity consistent with infection in six (86%) of seven aneurysms. MR imaging showed three saccular aneurysms. Adjacent abnormal vertebral body marrow signal intensity was seen in one (33%) of three patients.CONCLUSION: Saccular aneurysms (especially those with lobulated contour) with rapid expansion or development and adjacent mass, stranding, and/or fluid in an unusual location are highly suspicious for an infected aneurysm. (C) RSNA, 2004.