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Langguth P, Aludin S, Horr A, Campbell GM, Lebenatus A, Salehi Ravesh M, Schunk D, Austein F, Larsen N, Syrek H, Both M, Jansen O, Sedaghat S. Iodine uptake of adrenal glands: A novel and reliable spectral dual-layer computed tomographic-derived biomarker for acute septic shock. Eur J Radiol 2022; 156:110492. [PMID: 36108480 DOI: 10.1016/j.ejrad.2022.110492] [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: 06/03/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Septic shock is a potentially fatal condition. This study aims to assess whether iodine uptake and iodine density of abdominal organs on dual-layer spectral detector computed tomography (SDCT) could serve as a new imaging biomarker for patients in septic shock. METHODS Here, 95 patients who received contrast-enhanced abdominal CT examinations were included and separated into two groups: group A - septic shock; group B - no shock condition. Preselected abdominal (right and left adrenal gland, right and left kidney, infrarenal inferior vena cava (IVC), pancreas, spleen, and liver) localizations were independently evaluated by two radiologists, who measured iodine concentrations (mg/ml) and Hounsfield units (HU). RESULTS In all, 1520 measurements of iodine concentrations in mg/ml and HU were performed, with 27 patients in group A and 68 in group B. Iodine concentrations in mg/ml and HU correlated significantly in all organs measured. The corresponding correlation coefficient (r) ranged from 0.809 (pancreas) to 0.963 (right kidney). Inter-rater reliability (IRR) was very good for mg/ml (κ = 0.8; p < 0.01) and good for HU (κ = 0.773; p < 0.01) measurements. The mean iodine concentration and HU of the adrenal glands in septic and nonseptic patients was 4.88 ± 1.16 mg/ml/153 ± 36 HU and 2.67 ± 1.07 mg/ml/112 ± 41 HU, respectively. Iodine concentrations in the adrenal glands were significantly higher in group A than in group B patients (p < 0.01). The other organs remained unaffected and no significant difference was observed between patients in group A and B. Patients in group A presented significantly more often with an iodine uptake of >3.5 mg/ml of one adrenal gland (sensitivity = 0.926, specificity = 0.849, AUC = 0.951) or/and a combined concentration of >7 mg/ml of both adrenal glands (sensitivity = 0.889, specificity = 0.836, AUC = 0.928). CONCLUSION SDCT-derived iodine concentration of the adrenal glands could serve as a novel imaging biomarker for patients in acute septic shock. Our data suggest that an iodine uptake of >3.5 mg/ml of at least one adrenal gland or a combined iodine uptake of >7 mg/ml in both adrenal glands identifies patients in this condition.
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Affiliation(s)
- P Langguth
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany.
| | - S Aludin
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - A Horr
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | | | - A Lebenatus
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - M Salehi Ravesh
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - D Schunk
- Department for Interdisciplinary Emergency, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - F Austein
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N Larsen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - H Syrek
- Mediri GmbH, Heidelberg, Germany
| | - M Both
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - O Jansen
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany
| | - S Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Germany; Department of Radiology, University of California San Diego, San Diego, CA, United States
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Hollow adrenal gland sign on dual-phase contrast-enhanced CT in critically ill patients with sepsis. Am J Emerg Med 2020; 46:430-436. [PMID: 33143959 DOI: 10.1016/j.ajem.2020.10.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE We aimed to describe the clinical manifestations of patients with sepsis who had the hollow adrenal gland sign (HAGS) during the acute phase of resuscitation and evaluated its value in predicting in-hospital mortality. METHODS We performed a single-center, retrospective study of patients with sepsis who visited the emergency department (ED) from November 2015 to December 2018. The patients were categorized into the positive HAGS (pHAGS) and negative HAGS (nHAGS) groups, based on its presence in initial dual-phase contrast-enhanced abdominal computed tomography (CT). The primary outcome was in-hospital mortality. A multiple logistic regression model was developed to assess variables related to in-hospital mortality. RESULTS In all, 156 patients were included, and 36.5% (n = 57) was assigned to the pHAGS group. Both the maximal Sequential Organ Failure Assessment score within 24 h after ED arrival (10, interquartile range [IQR] 7-13 vs. 8, IQR 6-10, p < 0.01) and APACHE II score (24, IQR 20-31 vs. 20, IQR 17-25, p < 0.01) were significantly higher in the pHAGS than in the nHAGS group; the former group received significantly more interventions including vasopressors, renal replacement therapy, mechanical ventilation, and transfusions; in-hospital mortality was significantly higher in the former than in the latter group (29.8% vs. 10.1%, p < 0.01). pHAGS was an independent predictor of in-hospital mortality (adjusted odds ratio, 2.89; 95% confidence interval, 1.08-7.78; p = 0.04). CONCLUSIONS Patients with sepsis who showed the HAGS had more severe illness than those who did not, and had an increased need for organ-supportive interventions. Presence of the HAGS was independently associated with in-hospital mortality.
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Winzer R, Martin R, Baldus JC, Heidrich FM, Hoberück S, Hoffmann RT, Fedders D. Vascular changes of the superior mesenteric artery (SMA): A new component of the hypovolemic shock complex (HSC). Eur J Radiol 2020; 133:109370. [PMID: 33126176 DOI: 10.1016/j.ejrad.2020.109370] [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: 06/09/2020] [Revised: 09/08/2020] [Accepted: 10/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the type and frequency of vascular changes in the superior mesenteric artery (SMA) associated with the hypovolemic shock complex (HSC). METHODS Twenty-six patients (14 males, 70.6 ± 11.2 years) meeting the criteria for hypovolemic shock complex in computed tomography were examined for the presence of angiographic signs of non-occlusive mesenteric ischemia (NOMI) in the SMA: the string of sausages sign and spasms of the arcades of mesenteric arteries on coronal maximum intensity projection images (MIP). Interrater agreement was assessed using weighted kappa (κ). RESULTS Vascular changes of the SMA were visible in almost all of the patients with HSC with a frequency of 88.5 %-96.2 %. Intraclass correlation coefficients indicated a substantial to almost perfect interrater agreement. CONCLUSIONS Using computed tomography, it is possible to reliably and reproducibly detect vascular changes in SMA known from angiography in the context of hypoperfusion. The pathological vascular changes also occur more frequently than other classic signs of a CT hypoperfusion complex. Since the qualitative assessment of the SMA requires only a small amount of time, it is suitable as a further criterion for the presence of the CT hypoperfusion complex.
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Affiliation(s)
- Robert Winzer
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany.
| | - Ron Martin
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany
| | - Jan Christian Baldus
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany
| | - Felix Matthias Heidrich
- Department for Internal Medicine and Cardiology, TU Dresden, Fetscherstr. 76, 01307 Dresden, Germany
| | - Sebastian Hoberück
- Dresden University Hospital, Department of Nuclear Medicine, Fetscherstr. 74, 01307 Dresden, Germany
| | - Ralf-Thorsten Hoffmann
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany
| | - Dieter Fedders
- Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany
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Signs of post-traumatic hypovolemia on abdominal CT and their clinical importance: A systematic review. Eur J Radiol 2020; 124:108800. [DOI: 10.1016/j.ejrad.2019.108800] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/02/2019] [Accepted: 12/13/2019] [Indexed: 01/12/2023]
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Contrast-Enhanced Computed Tomography in Intensive Care Unit Patients With Acute Clinical Deterioration: Impact of Hyperattenuating Adrenal Glands. Can Assoc Radiol J 2016; 68:21-26. [PMID: 28010910 DOI: 10.1016/j.carj.2016.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 06/14/2016] [Accepted: 07/06/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The study sought to assess the frequency and prognostic value of hyperattenuating adrenal glands on contrast-enhanced computed tomography (CT) scans of surgical intensive care unit (ICU) patients with acute clinical deterioration. METHODS Eighty-eight consecutive ICU patients (63.2 ± 14.5 years of age) were included in this retrospective analysis. All patients underwent biphasic contrast-enhanced CT due to an acute clinical deterioration. Hyperattenuation of the adrenal glands was assessed subjectively and objectively. Subjective presence or absence of hyperattenuating adrenal glands was assessed by 2 blinded radiologists (J.B. and R.S.L.) in consensus. Hounsfield units (HU) were measured in the adrenal glands and in the inferior vena cava. Objective hyperattenuation was defined as HU (adrenal glands) > HU (inferior vena cava) with a 15-HU threshold. Death within 14 days following CT was set as endpoint and acquired from electronic patient data. RESULTS Thirty-eight patients (43.2%, Group Asubj) exhibited hyperattenuation of the adrenal glands, whereas 50 patients (56.8%, Group Bsubj) did not. Concerning the objective analysis, 31 patients (35.2%, Group Aobj) exhibited hyperdense adrenal glands, whereas 53 patients (64.8%, Group Bobj) did not. Overall 27 of 88 patients (30.6%) died within 14 days following the CT examination. Lethal outcome was significantly more frequent among patients in Group Asubj and Aobj (19 of 38 patients [50.0%] and 15 of 31 patients [48.4%]) as compared with patients in Group Bsubj (8 of 50 patients [16.0%]) and Group Bobj (12 of 57 patients [21.1%]; P < .05). Subjective and objective analysis correlated significantly (P < .05). CONCLUSIONS Hyperattenuation of adrenal glands on contrast-enhanced CT of ICU patients with acute clinical deterioration is associated with a high mortality and might serve as a prognostic marker for patients' outcome.
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Higashi H, Kanki A, Watanabe S, Yamamoto A, Noda Y, Yasokawa K, Higaki A, Tamada T, Ito K. Traumatic hypovolemic shock revisited: the spectrum of contrast-enhanced abdominal computed tomography findings and clinical implications for its management. Jpn J Radiol 2014; 32:579-84. [PMID: 25173684 DOI: 10.1007/s11604-014-0354-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 08/15/2014] [Indexed: 11/26/2022]
Abstract
Hypovolemic shock is often seen in patients with severe blunt trauma who have suffered from blood circulation inadequate to maintain oxygen delivery to multiple organs. The early recognition and prompt management of hypovolemic shock in patients with multiple injuries are mandatory to improving prognosis and patient conditions. The diagnostic accuracy of computed tomography (CT) as a primary diagnostic tool is well established. The abdominal organs show several common and classic appearances on contrast-enhanced CT in patients with trauma. The hypovolemic shock complex is reported in the previous literature as decreased enhancement of the viscera, increased mucosal enhancement and luminal dilation of the small bowel, mural thickening and fluid-filled loops of the small bowel, the halo sign and flattening of the inferior vena cava, reduced aortic diameter, and peripancreatic edema. However, there have been controversial CT reports with contradictory appearances. Physicians understanding these findings could prompt alternative approaches to the early assessment and management of hypovolemic shock. The aim of this article is to illustrate common and well-known abdominal CT features in patients with traumatic hypovolemic shock, to discuss controversial CT signs in the pancreas and adrenal gland, and to describe CT findings' clinical implications when managing hypovolemic shock.
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Affiliation(s)
- Hiroki Higashi
- Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan,
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Clinical impact of hyperattenuation of adrenal glands on contrast-enhanced computed tomography of polytraumatised patients. Eur Radiol 2013; 24:527-30. [DOI: 10.1007/s00330-013-3050-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/24/2013] [Accepted: 09/30/2013] [Indexed: 10/26/2022]
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Higashi H, Tamada T, Kanki A, Yamamoto A, Ito K. Hypovolemic shock complex: does the pancreatic perfusion increase or decrease at contrast-enhanced dynamic CT? Clin Imaging 2013; 38:31-4. [PMID: 24139836 DOI: 10.1016/j.clinimag.2013.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 08/14/2013] [Accepted: 09/11/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate contrast enhancement effects of the pancreas at dynamic computed tomography (CT) to clarify whether pancreatic perfusion increases or decreases in severe trauma patients with hypovolemic shock. METHODS A total of 90 patients with (n=30) and without (n=60) blunt trauma and hypovolemic shock who underwent dynamic CT for abdomen was included. The measurement of CT attenuation values of the pancreas in the early phase and the late phase was performed to compare the contrast enhancement effects between patients with and without hypovolemic shock. RESULTS The mean CT attenuation values of the pancreas in the early phase of dynamic CT in patients with hypovolemic shock [95.4±29.1 Hounsfield units (HU)] were significantly lower (P < .001) than those in non-hypovolemic patients (136.6±17.9 HU), indicating decreased pancreatic perfusion in patients with hypovolemic shock. The mean CT attenuation values of the pancreas in the late phase of dynamic CT in patients with hypovolemic shock (95.9±17.6 HU) were significantly higher (P < .026) than those in non-hypovolemic patients (87.2±9.0 HU), indicating delayed or prolonged pancreatic enhancement in patients with hypovolemic shock. CONCLUSIONS Decreased pancreatic perfusion in the early phase and delayed pancreatic enhancement in the late phase of contrast-enhanced dynamic CT was a common finding in patients with hypovolemic shock.
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Affiliation(s)
- Hiroki Higashi
- Department of Diagnostic Radiology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan
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Retrospective analysis of contrast-enhanced computed tomographic findings related to obstructive shock due to ascending aortic dissection. J Comput Assist Tomogr 2012; 36:60-6. [PMID: 22261771 DOI: 10.1097/rct.0b013e318245c079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate contrastenhanced computed tomography findings related to obstructive shock due to ascending aortic dissection (AAD). METHODS The computed tomography findings in 9 AAD patients with shock, 11 AAD patients without shock, and 18 control subjects were evaluated for (1) pericardial effusion, (2) diameter of the inferior vena cava, (3) periportal hypodensity, (4) retrograde reflux of contrast material, (5) aortic and visceral enhancement, and (6) other factors (peripancreatic edema, bowel thickening/dilatation). RESULTS Patients with shock showed the highest ratio of pericardial effusion, periportal hypodensity, and retrograde reflux of contrast material; largest inferior vena cava diameter; stronger aortic enhancement in both the arterial and portal phases; lowered splenic and pancreatic enhancement in the arterial phase; and stronger visceral (especially adrenal) enhancement, except for the renal medulla in the portal phase. CONCLUSIONS Computed tomography findings related to obstructive shock due to AAD reflected impaired diastolic filling, decreased cardiac output, and flow redistribution in visceral organs.
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