Adrenal glands enhancement in computed tomography as predictor of short-and intermediate term mortality in critically ill patients

Winzer, Robert; Martin, Ron; Kühn, Jens‐Peter; Baldus, Jan Christian; Seppelt, Danilo; Heidrich, Felix M.; Hoberück, Sebastian; Hoffmann, Ralf‐Thorsten; Fedders, Dieter

doi:10.1016/j.clinimag.2020.10.033

Cited by 5 publications

(13 citation statements)

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“…Die Milz ist ein gut perfundiertes Organ, das als Reservoir für Thrombozyten und rote Blutkörperchen gilt [15]. In lebensbedrohlichen Zuständen scheinen die Aktivierung des sympathischen Nervensystems sowie humorale Effekte auf die Versorgungsgefäße und das milzeigene Bindegewebe den arteriellen Zufluss zu vermindern und den venösen Abfluss zu erhöhen [6].…”

Section: Diskussionunclassified

“…In ROC (receiver operating characteristics) analyses, the portal venous contrast phase showed the greatest relationship between organ density values and mortality. In this phase organ densities already have a substantial predictive value regarding the risk of death within the first three days after imaging [15]. However, the quality of the prediction increases significantly when the organ density values are viewed in relation to one another or to the large abdominal vessels [16].…”

Section: Introductionmentioning

confidence: 99%

“…Im klinisch-radiologischen Alltag fielen uns bei einer Vielzahl dieser Patienten hyperdense Nebennieren in der kontrastmittelgestützten CT auf, wobei einige Patienten in den Folgetagen verstarben. Die unterschiedlichen Ansätze vorangegangener Studien bezüglich der Auswahl der Kontrastmittelphasen und der Organe bewogen uns zunächst zu einem systematischen Vergleich des Anreicherungsver-haltens in der arteriellen und portalvenösen Phase auf Grundlage ROI-basierter Messungen [15,16]. Wir fokussierten uns auf die Nebennieren und die Milz sowie die großen Abdominalgefäße.…”

Section: Introductionunclassified

“…Die portalvenöse Kontrastmittelphase zeigte in ROC (receiver operating characteristics)-Analysen den stärksten Zusammenhang zwischen Organdichtewerten und Mortalität auf. In dieser Phase besitzen schon die Organdichten für sich einen substanziellen Vorhersagewert, innerhalb der ersten 3 Tage nach Bildgebung zu versterben [15]. Die Güte der Vorhersage wird jedoch entscheidend gesteigert, wenn die Organdichtewerte entweder in Relation zueinander oder zu den großen Abdominalgefäßen gesetzt werden [16].…”

Section: Introductionunclassified

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The Portal-Venous Enhancement Ratio of the Adrenal Glands and Spleen as a Short-Term Predictor of Mortality in Intensive Care Patients

Winzer

Hoffmann

Fedders

2022

Rofo

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Background 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. Method 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. Results 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. Conclusion 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. Key Points: Citation Format

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Section: Diskussionunclassified

Section: Introductionmentioning

confidence: 99%

Section: Introductionunclassified

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The Portal-Venous Enhancement Ratio of the Adrenal Glands and Spleen as a Short-Term Predictor of Mortality in Intensive Care Patients

Winzer

Hoffmann

Fedders

2022

Rofo

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“…Nine measures are used in this study: sensitivity, specificity, precision, accuracy, F1 score, Matthews correlation coefficient (MCC) [33], Fowlkes-Mallows index (FMI) [34], receiver operating characteristic (ROC), area under the curve (AUC). The first four measures are defined as.…”

Section: Methodsmentioning

confidence: 99%

Secondary Pulmonary Tuberculosis Identification Via pseudo-Zernike Moment and Deep Stacked Sparse Autoencoder

et al. 2021

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Secondary pulmonary tuberculosis (SPT) is one of the top ten causes of death from a single infectious agent. To recognize SPT more accurately, this paper proposes a novel artificial intelligence model, which uses Pseudo Zernike moment (PZM) as the feature extractor and deep stacked sparse autoencoder (DSSAE) as the classifier. In addition, 18-way data augmentation is employed to avoid overfitting. This model is abbreviated as PZM-DSSAE. The ten runs of 10-fold cross-validation show this model achieves a sensitivity of 93.33% ± 1.47%, a specificity of 93.13% ± 0.95%, a precision of 93.15% ± 0.89%, an accuracy of 93.23% ± 0.81%, and an F1 score of 93.23% ± 0.83%. The area-under-curve reaches 0.9739. This PZM-DSSAE is superior to 5 state-of-the-art approaches.

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Portal venous contrast enhancement ratio of the adrenal glands and spleen as prognostic marker of mortality in patients with acute mesenteric ischemia

Pfister,

Mehdorn,

Schwartner

et al. 2024

Abdom Radiol

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Purpose Contrast enhancement of the adrenal gland defined by computed tomography (CT) was previously analyzed as a prognostic factor for critically ill patients in various diseases. However, no study investigated this quantitative parameter in patients with acute mesenteric ischemia. Therefore, the aim of this study was to evaluate the prognostic value of the contrast enhancement of the adrenal glands in patients with clinically suspected AMI. Methods All patients with clinically suspected AMI were retrospectively assessed between 2016 and 2020. All patients underwent surgical exploration after CT imaging. Overall, 134 patients (52 female patients, 38.8%) with a mean age of 69.2 ± 12.4 years were included into the present analysis. For all patients, the preoperative CT was used to calculate the contrast media enhancement of the adrenal glands and the spleen. Results A total of 27 patients (18.5%) died within the first 24 h and over the following 30-day 94 patients (68.6%) died. There were statistically significant differences regarding the mean values for adrenal-to-spleen ratio for 24-h mortality (p = 0.001) and 30-day mortality (p = 0.004), whereas the radiodensity of the inferior vena cava and the radiodensity of the spleen was statistically significant between survivors and non-survivors after 30 days (p = 0.037 and p = 0.028, respectively). In Cox regression analysis, mean adrenal radiodensity was associated with 24-h mortality (HR 1.09, 95% CI 1.02–1.16, p = 0.01) but not with 30-day mortality (HR 1.03, 95% CI 0.99–1.07, p = 0.13). Conclusion The contrast media enhancement of the adrenal gland is associated with the 24-h and 30-day mortality in patients with AMI. However, the prognostic relevance for translation into clinical routine needs to be validated in other cohorts. Graphical abstract

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Adrenal glands enhancement in computed tomography as predictor of short-and intermediate term mortality in critically ill patients

Cited by 5 publications

References 14 publications

The Portal-Venous Enhancement Ratio of the Adrenal Glands and Spleen as a Short-Term Predictor of Mortality in Intensive Care Patients

The Portal-Venous Enhancement Ratio of the Adrenal Glands and Spleen as a Short-Term Predictor of Mortality in Intensive Care Patients

Secondary Pulmonary Tuberculosis Identification Via pseudo-Zernike Moment and Deep Stacked Sparse Autoencoder

Portal venous contrast enhancement ratio of the adrenal glands and spleen as prognostic marker of mortality in patients with acute mesenteric ischemia

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