1
|
Ren L, Fei X, Zhao Y, Xie F, Xue S, Li N, Nie F, Luo Y. Diagnostic value of contrast-enhanced ultrasound in the activity of idiopathic retroperitoneal fibrosis: a retrospective study. Clin Rheumatol 2024; 43:1207-1215. [PMID: 38329616 DOI: 10.1007/s10067-023-06855-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/01/2023] [Accepted: 11/24/2023] [Indexed: 02/09/2024]
Abstract
OBJECTIVES To explore the diagnostic value of contrast-enhanced ultrasound (CEUS) in the disease activity of idiopathic retroperitoneal fibrosis (IRPF). METHODS This retrospective study included 148 CEUS examinations from 63 patients with IRPF treated in our hospital from April 2016 to September 2021. They were divided into two groups: IRPF active group (69 examinations) and inactive group (79 examinations). Uni- and multivariable analyses were used to identify independent risk factors for IRPF activity. Receiver operating characteristic (ROC) curves were drawn to establish different diagnostic models to evaluate the diagnostic value of IRPF activity. The z test was used to compare the differences of the area under the curves (AUCs). The value of CEUS in evaluating the variation of disease activity over time was also investigated between repeat patient studies. RESULTS Univariate and multivariate logistic regression analyses revealed the thickness [odds ratio (OR) = 14.125, 95% confidence interval (CI) = 3.017-66.123] was the most significant independent risk factor for IRPF activity (P < 0.01). The best diagnostic model was model 3, which was established by CEUS score combined with thickness. The AUC was 0.944 (95%CI = 0.912-0.977), and the sensitivity and specificity were 89.86% and 86.08%, respectively. The diagnostic performance was not significantly improved after combining clinical symptom (back pain) and laboratory indicators [erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)]. Compared with before treatment, the CEUS score and thickness were significantly decreased after treatment (x2 = 14.580, P < 0.001 and z = 4.708, P < 0.001, respectively). CONCLUSION CEUS has good diagnostic value for IRPF disease activity. Key points • Thickness and contrast-enhanced ultrasound score were significantly higher in the active group than those in inactive group (P < 0.001). • With thickness of 4 mm and contrast-enhanced ultrasound 2 score as optimal cut-off values, the sensitivity and specificity were 89.86%, 81.01% and 52.17%, 100.00%, respectively. • During follow-up, when the disease progressed, the change of CEUS score was earlier than the change of thickness.
Collapse
Affiliation(s)
- Ling Ren
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
- The Second Medical College of Lanzhou University, Chengguan District, No.222 Tianshui South Road, Lanzhou, 730030, Gansu, China
| | - Xiang Fei
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Yurong Zhao
- Department of Rheumatology, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Fang Xie
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Shaowei Xue
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Nan Li
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China
| | - Fang Nie
- The Second Medical College of Lanzhou University, Chengguan District, No.222 Tianshui South Road, Lanzhou, 730030, Gansu, China.
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, No. 28 Fuxing Road, Beijing, 100853, China.
- The Second Medical College of Lanzhou University, Chengguan District, No.222 Tianshui South Road, Lanzhou, 730030, Gansu, China.
| |
Collapse
|
2
|
Xu J, Bettendorf B, D'Oria M, Sharafuddin MJ. Multidisciplinary diagnosis and management of inflammatory aortic aneurysms. J Vasc Surg 2022:S0741-5214(22)02645-3. [PMID: 36565773 DOI: 10.1016/j.jvs.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 12/07/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Inflammatory abdominal aortic aneurysms (IAAAs) are a variant involving a distinct immunoinflammatory process, with nearly one half believed to be associated with IgG4-related disease (IgG4-RD). METHODS MEDLINE and Google Scholar searches were conducted for English-language publications relevant to inflammatory aortic aneurysms from January 1970 onward. The search terms included inflammatory aortic aneurysms, aortitis, periaortitis, IgG4-related disease, and retroperitoneal fibrosis. Relevant studies were selected for review based on their relevance. RESULTS Morphologically, IAAAs are characterized by a thickened aneurysm wall often displaying contrast enhancement and elevated metabolic activity on fluorine-18 fluorodeoxyglucose-positron emission tomography imaging. A strong association exists with perianeurysmal and retroperitoneal fibrosis. Although the rupture risk appears lower with IAAAs than with noninflammatory abdominal aortic aneurysms (AAAs), the currently recommended diameter threshold for operative management is the same. Open repair has been associated with increased morbidity compared with noninflammatory AAAs, and a retroperitoneal approach or minimal dissection transperitoneal approach has been recommended to avoid duodenal and retroperitoneal structural injuries. Endovascular aneurysm repair has been increasingly used, especially for patients unfit for open surgery. It is important to exclude an infectious etiology before the initiation of immunosuppressive therapy or operative repair. Multimodality imaging follow-up is critical to monitor disease activity and secondary involvement of retroperitoneal structures by the associated fibrotic process. Maintenance of immunosuppressive therapy will be needed postoperatively for most patients with active systemic disease, especially those with IgG4-RD and those with persistent symptoms. Additional interventions aimed at ureteral decompression could also be required, and lifelong follow-up is mandatory. CONCLUSIONS Preoperative multimodality imaging is a diagnostic cornerstone for assessment of the disease extent and activity. IgG4-RD is an increasingly recognized category of IAAAs, with implications for tailoring adjunctive medical therapy. Open surgical repair remains the procedure of choice, although endovascular aneurysm repair is increasingly being offered. Maintenance immunosuppressive therapy can be offered according to the disease activity as assessed by follow-up imaging studies.
Collapse
Affiliation(s)
- Jun Xu
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Brittany Bettendorf
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Mario D'Oria
- Division of Vascular and Endovascular Surgery, Cardiovascular Department, University Hospital of Trieste, Trieste, Italy
| | - Mel J Sharafuddin
- Division of Vascular Surgery, University of Iowa Carver College of Medicine, Iowa City, IA.
| |
Collapse
|
3
|
Peisen F, Thaiss WM, Ekert K, Horger M, Amend B, Bedke J, Nikolaou K, Kaufmann S. Retroperitoneal Fibrosis and its Differential Diagnoses: The Role of Radiological Imaging. ROFO-FORTSCHR RONTG 2020; 192:929-936. [DOI: 10.1055/a-1181-9205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background Retroperitoneal fibrosis is a rare disease with an incidence of 0–1/100 000 inhabitants per year and is associated with chronic inflammatory fibrosis of the retroperitoneum and the abdominal aorta. This article sheds light on the role of radiological imaging in retroperitoneal fibrosis, names various differential diagnoses and provides an overview of drug and surgical treatment options.
Methods A literature search for the keywords “retroperitoneal fibrosis” and “Ormond’s disease” was carried out in the PubMed database between January 1, 1995 and December 31, 2019 (n = 1806). Mainly original papers were selected, but also reviews, in English and German language, with a focus on publications in the last 10 years, without excluding older publications that the authors believe are relevant to the topic discussed in the review (n = 40).
Results and Conclusion Ormond’s disease is a rare but important differential diagnosis for nonspecific back and flank pain. Imaging diagnostics using CT or MRI show a retroperitoneal mass, which must be differentiated from lymphoma, sarcoma, multiple myeloma and Erdheim-Chester disease. Patients have an excellent prognosis under adequate therapy. FDG-PET/CT or FDG-PET/MRT should be considered as potential modalities, as hybrid imaging can evaluate both the morphological changes and the inflammation.
Key Points:
Citation Format
Collapse
Affiliation(s)
- Felix Peisen
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Wolfgang Maximilian Thaiss
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Kaspar Ekert
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Marius Horger
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Bastian Amend
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Jens Bedke
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Sascha Kaufmann
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tübingen, Tübingen, Germany
| |
Collapse
|