Computerized tomography features acting as predictors for invasive therapy in the management of Crohn's disease-related spontaneous intra-abdominal abscess: experience from long-term follow-up.

IF 2.9 3区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING BMC Medical Imaging Pub Date : 2024-11-05 DOI:10.1186/s12880-024-01475-2
Yinghao Sun, Wei Liu, Ye Ma, Hong Yang, Yue Li, Bei Tan, Ji Li, Jiaming Qian
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Abstract

Background: Decision-making in the management of Crohn's disease (CD)-related spontaneous intra-abdominal abscess (IAA) is challenging. This study aims to reveal predictive factors for percutaneous drainage and/or surgery in the treatment of CD-related spontaneous IAA through long-term follow-up.

Methods: Data were collected, including clinical manifestations, radiography and treatment strategies, in Chinese patients with CD-related IAA in a tertiary medical center. Univariate and Multivariate Cox analysis were conducted to identify predictors for invasive therapy.

Results: Altogether, 48 CD patients were identified as having IAA through enhanced CT scans. The median follow-up time was 45.0 (23.3, 58.0) months. 23 (47.9%) patients underwent conservative medical treatment, and 25 (52.1%) patients underwent percutaneous drainage and/or surgical intervention (invasive treatment group). The 1-, 2-, and 5-year overall survival rates without invasive treatment were 75.0%, 56.1%, and 46.1%, respectively. On univariate Cox analysis, the computerized tomography (CT) features including nonperienteric abscess (HR: 4.22, 95% CI: 1.81-9.86, p = 0.001), max abscess diameter (HR: 1.01, 95% CI: 1.00-1.02, p<0.001) and width of sinus (HR: 1.27, 95% CI: 1.10-1.46, p = 0.001) were significantly associated with invasive treatment. Nonperienteric abscess was significantly associated with invasive treatment on multivariate Cox analysis (HR: 3.11, 95% CI: 1.25-7.71, p = 0.015). A score model was built by width of sinus, location of abscess and max abscess diameter to predict invasive treatment. The AUC of ROC, sensitivity and specificity were 0.892, 80.0% and 90.9% respectively.

Conclusions: More than half of CD-related IAA patients needed invasive therapy within 5-year follow-up. The CT features including nonperienteric abscess, larger maximum abscess diameter and width of sinus suggested a more aggressive approach to invasive treatment.

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在治疗与克罗恩病相关的自发性腹腔内脓肿时,计算机断层扫描特征可作为侵入性疗法的预测因素:长期随访的经验。
背景:克罗恩病(CD)相关自发性腹腔内脓肿(IAA)的治疗决策具有挑战性。本研究旨在通过长期随访揭示经皮引流术和/或手术治疗克罗恩病相关自发性腹腔内脓肿的预测因素:方法:在一家三级医疗中心收集了中国 CD 相关 IAA 患者的数据,包括临床表现、影像学检查和治疗策略。结果:共发现 48 例 CD 相关 IAA 患者:结果:共有 48 名 CD 患者通过增强 CT 扫描被确定患有 IAA。中位随访时间为 45.0 (23.3, 58.0) 个月。23名患者(47.9%)接受了保守治疗,25名患者(52.1%)接受了经皮引流和/或手术治疗(侵入性治疗组)。未经侵入性治疗的1年、2年和5年总生存率分别为75.0%、56.1%和46.1%。在单变量 Cox 分析中,计算机断层扫描(CT)特征包括非全腹腔脓肿(HR:4.22,95% CI:1.81-9.86,p = 0.001)、最大脓肿直径(HR:1.01,95% CI:1.00-1.02,p 结论:超过半数的CD相关IAA患者在5年随访期内需要进行侵入性治疗。CT特征包括非腹腔脓肿、较大的最大脓肿直径和脓窦宽度,这表明需要采取更积极的侵入性治疗方法。
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来源期刊
BMC Medical Imaging
BMC Medical Imaging RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
CiteScore
4.60
自引率
3.70%
发文量
198
审稿时长
27 weeks
期刊介绍: BMC Medical Imaging is an open access journal publishing original peer-reviewed research articles in the development, evaluation, and use of imaging techniques and image processing tools to diagnose and manage disease.
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