Abstract
The aim of this investigation was to evaluate predictive CT imaging features and clinical parameters to distinguish infected from sterile fluid collections. Detection of infectious agents by advanced microbiological analysis was used as the reference standard. From April 2018 to October 2019, all patients undergoing CT-guided drainages were prospectively enrolled, if drainage material volume was at least 5 mL. Univariate analysis revealed attenuation (p = 0.001), entrapped gas (p < 0.001), fat stranding (p < 0.001), wall thickness (p < 0.001) and enhancement (p < 0.001) as imaging biomarkers and procalcitonin (p = 0.003) as clinical predictive parameters for infected fluid collections. On multivariate analysis, attenuation > 10 HU (p = 0.038), presence of entrapped gas (p = 0.027) and wall enhancement (p = 0.028) were independent parameters for distinguishing between infected and non-infected fluids. Gas entrapment had high specificity (93%) but low sensitivity (48%), while wall enhancement had high sensitivity (91%) but low specificity (50%). CT attenuation > 10 HU showed intermediate sensitivity (74%) and specificity (70%). Evaluation of the published proposed scoring systems did not improve diagnostic accuracy over independent predictors in our study. In conclusion, this prospective study confirmed that CT attenuation > 10 HU, entrapped gas and wall enhancement are the key imaging features to distinguish infected from sterile fluid collections on CT.
Highlights
Written informed consent was obtained from all participants prior to enrollment. This prospective study was conducted between April 2018 and October 2019, and included 100 consecutive computed tomography (CT)-guided drainages from foci suspicious for infection
Patients were eligible for this study if they were referred for a clinically indicated CT-guided aspiration or drainage of one or more suspected infection foci
Collections, applied to our cohort. This prospective study demonstrated that the imaging parameters gas entrapment, prospective study demonstrated the imaging parameters gas entrapment, wallThis enhancement and CT attenuation are that independent predictors of infected fluid collecwall enhancement and attenuation are independent predictors of infected tions
Summary
Percutaneous drainage of infected fluid collections is recommended and generally accepted as the preferred treatment in eligible patients [1]. Percutaneous abscess drainage has a high therapeutic success rate and should be the therapy of choice because it is less invasive and less expensive than surgical drainage [2,3,4]. In addition to the therapeutic importance of CT, its role in diagnosing abscesses and other processes of infection is promising. In CT-guided drainage of postoperative abdominal fluid collections, the detection rate for microorganisms is 48–78% [7,8,9]. Studies on image-guided drainage in suspected spondylodiscitis describe a lower detection rate of 27–65% [10,11,12,13]. Thereby, better detection of pancreatic fluid [14], hepatic abscess [15], early spondylodiscitis [16] and brain abscess [17] can be shown for diffusion-weighted MRI
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