Sensitivity and Specificity of CT in the Diagnosis of Inflammatory Abdominal Aortic Aneurysms

Iino, Misako; Kuribayashi, Sachio; Imakita, Satoshi; Takamiya, Makoto; Matsuo, Hiroshi; Ookita, Yutaka; Ando, Motomi; Ueda, Hatsue

doi:10.1097/00004728-200211000-00026

Cited by 77 publications

(42 citation statements)

References 15 publications

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“…Clinically, inflammatory aneurysm may present with back pain, weight loss, fatigue, and elevated erythrocyte sedimentation rate, more commonly in men (90). Classic imaging findings include a low density, mildly enhancing soft tissue mass anterolateral to and surrounding the calcified aortic wall (91). When rupture occurs, inflammatory aortic aneurysms may confer a higher operative mortality compared with atherosclerotic aneurysms (92).…”

Section: A B Cmentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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Aortitis is aortic inflammation, which can be due to inflammatory or infectious diseases. Left undiagnosed, aortitis can lead to aneurysm formation and rupture, in addition to ischemic compromise of major organs. Infectious aortic diseases include mycotic aneurysm and graft infection; the most common inflammatory diseases are Takayasu's and giant cell arteritis. We review the epidemiology, etiology, presentation and diagnosis, and treatment of these entities. S62infectious extravascular source adjacent the arterial wall (16,17). Bacteria may seed the arterial wall injury either from bacteremia or septic emboli (18). Typically, infection initiates in a nidus such as in an ulcerated atherosclerotic plaque or in the vasa vasorum (12). The vasa vasorum is thought to be key in the pathogenesis of MA formation; due to its small lumen size and slower flow, it is more susceptible to bacterial colonization (19,20). The vasa vasorum is more pronounced in larger arteries, which may explain why the aorta is the most common site of MA formation. DiagnosisEarly diagnosis and rapid triage for intervention is key to reducing mortality from MA (21,22). However, diagnosis is challenging given the low prevalence and nonspecific symptoms. Clinical signs may include fever and laboratory abnormalities including elevated erythrocyte sedimentation rate and leukocytosis (23). Bacteremia is common, though cultures may be negative, particularly after antibiotics have been given. Symptoms include pain or a pulsatile mass (23). In the setting of pre-existing endocarditis, prior invasive procedures, intravenous drug use or immunocompromise should increase suspicion (8,24).Non-invasive cross-sectional imaging is essential in the diagnosis of MA. Computed tomography angiography (CTA) has arisen as the imaging modality of choice owing to its excellent resolution allowing for three-dimensional reconstruction and its rapid acquisition; magnetic resonance imaging (MRI) may also be used (25)(26)(27). Certain features may distinguish MA from non-infected aneurysms, including serial imaging which may reveal rapid progression typical of infected aneurysms. Other characteristic features include contrast-enhancement and a saccular outpouching configuration, whereas non-infected atherosclerotic aneurysms tend to be fusiform (28). Saccular configuration may also suggest imminent rupture, alerting the need for further urgent diagnostic workup. Other features include irregularity of the arterial wall and peri-aortic gas, edema, mass or stranding (28). MAs also tend to have higher uptake on FDG-PET imaging of 4.5 SUV max or more compared with non-infected aneurysms (29). FDG-PET boasts high sensitivity and its potentially high false-positive rate can be improved with simultaneous CT. Treatment and prognosisDue to its elusive presentation, MA is often difficult to treat because of delayed diagnosis. Rapid diagnosis and treatment is key, as aortic MA is associated with 15-50% mortality (7)(8)(9)24). No randomized trials are available to guide manage...

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Section: A B Cmentioning

confidence: 99%

Inflammatory and infectious aortic diseases

Deipolyi

Czaplicki

Öklü

2018

Cardiovasc. Diagn. Ther.

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“…One study of 355 patients with AAA estimated that CT scanning was 83.3% sensitive and 99.7% specific in diagnosing the inflammatory variant. 26 Magnetic resonance imaging is also very sensitive in demonstrating the aneurysm, the thickening of the wall (even better than CT), and the surrounding periaortic inflammation. Magnetic resonance imaging also avoids the radiation exposure and administration of nephrotoxic intravenous contrast material required with CT. 19 The periaortic mass in inflammatory AAA is hypointense on T1-weighted images, but hyperintense on T2-weighted images.…”

Section: Imagingmentioning

confidence: 99%

Inflammatory Abdominal Aortic Aneurysm

Hellmann

Grand

Freischlag

2007

JAMA

125

110

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“…Accordingly, CECT has been reported to have a sensitivity and specificity of 83% and 100%, respectively. 19 However, the finding of a thickened aortic wall or periaortic soft-tissue formation alone cannot distinguish active inflammation from chronic fibrotic lesion. Therefore, contrary to MRI and 18 F-FDG-PET, CECT is considered to be less sensitive for assessment of disease activity.…”

Section: Discussionmentioning

confidence: 99%

Perfusion-based assessment of disease activity in untreated and treated patients with aortitis and chronic periaortitis: correlation with CT morphological, clinical and serological data

Bier¹,

Henes²,

Eulenbruch³

et al. 2015

BJR

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Objective: To evaluate the role of perfusion-based assessment of inflammatory activity in patients with treated and untreated aortitis and chronic periaortitis as compared with clinical and serological markers. Methods: 35 patients (20 females; median age 66 years) with (peri) aortitis were retrospectively evaluated. All patients had clinical symptoms prompting at the time of imaging. All patients first underwent whole-body contrastenhanced CT and subsequently segmental volume perfusion CT for assessment of the degree of vascularization of (peri) aortitis as a surrogate marker for inflammatory activity. Blood flow, blood volume, volume transfer constant (k-trans), time to peak and mean transit time were determined. The thickness of the increased connective tissue formation was measured. Perfusion data were correlated with clinical symptoms and acute-phase inflammatory parameters such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and leukocyte number.Results: 21 of 35 patients were untreated and 14 of 35 had previous/ongoing immunosuppression. The interobserver agreement was good (k 5 0.78) for all perfusion parameters. Average values of perfusion parameters were higher in untreated patients but remained abnormally elevated in treated patients as well. Perfusion data and ESR and CRP correlated well both in aortitis (p , 0.05) and in periaortitis (p , 0.05). In periaortitis, perfusion parameters agreed well with ESR and CRP values (p , 0.05) only in untreated patients. Conclusion: Perfusion CT parameters in untreated aortitis and chronic periaortitis correlate well with serological markers with respect to disease activity assessment. However, in treated periaortitis, correlations were weak, suggesting an increased role for (perfusion-based) imaging. Advances in knowledge: Volume perfusion CT may be used for diagnosis of aortitis/periaortitis.

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Sensitivity and Specificity of CT in the Diagnosis of Inflammatory Abdominal Aortic Aneurysms

Abstract: CT scan with contrast enhancement was a highly reliable imaging modality for the diagnosis of IAAA.

Cited by 77 publications

References 15 publications

Inflammatory and infectious aortic diseases

Inflammatory and infectious aortic diseases

Inflammatory Abdominal Aortic Aneurysm

Perfusion-based assessment of disease activity in untreated and treated patients with aortitis and chronic periaortitis: correlation with CT morphological, clinical and serological data

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