中国实用外科杂志

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血管移植物感染影像学特征及评价

杨    蕾1a,2,王    冠1a,辛世杰1b   

  1. 1中国医科大学附属第一医院  a.放射科 b. 血管外科,辽宁沈阳110001;2国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院影像诊断科,北京100021
  • 出版日期:2024-12-01

  • Online:2024-12-01

摘要: 血管移植物感染(VGI)是血管移植术后的罕见但严重的并发症,其高致死率和致残率对病人的健康构成重大威胁。明确诊断和及时治疗对于改善病人预后具有重要意义。VGI的诊断主要依赖于临床表现、实验室检查和影像学检查。影像学检查在早期发现感染灶、评估病变范围和性质方面发挥了关键作用。临床表现方面,VGI通常表现为发热、不明原因的菌血症、体重减轻、局部疼痛等非特异性症状。实验室检查中常见炎症指标如白细胞计数、C反应蛋白和红细胞沉降率升高,但特异性较低,基因检测等新兴技术可显著提高病原体检测的阳性率。影像学检查包括超声、CT、MRI和核医学成像。CT血管成像(CTA)是疑似VGI的首选检查,可直观显示感染特征,如血管周围的积气、积液和假性动脉瘤等。18氟-脱氧葡萄糖正电子发射计算机断层扫描(18F-FDG PET/CT)具有较高的敏感度,可显示感染的代谢信息,在诊断和鉴别诊断中提供重要依据。主动脉移植物感染管理协作组(MAGIC)标准为VGI的诊断提供了系统的分类方法,包括主要指标和次要指标,当满足一个主要指标或来自不同类别的两个次要指标时,需高度怀疑VGI。通过影像学检查、实验室检测与临床表现的综合评估,可实现对VGI的早期识别和诊断,为后续治疗提供可靠依据。影像学技术在确定病变范围、指导手术规划及治疗效果评估中具有不可替代的价值。未来,随着成像技术的进一步发展,VGI的诊断和治疗将更加精确高效。

关键词: 血管移植物感染, 影像学检查, 诊断标准, 计算机断层扫描(CT), 核磁共振成像(MRI), 正电子发射计算机断层扫描(PET/CT), 血清学检测, MAGIC标准

Abstract: Vascular graft infection (VGI) is a rare but severe complication following vascular graft surgery, characterized by high mortality and morbidity rates, which pose a significant threat to patients’ health. Accurate diagnosis and timely treatment are crucial for improving patient prognosis. The diagnosis of VGI primarily relies on clinical presentations, laboratory tests, and imaging studies. Imaging plays a key role in the early detection of infection and evaluation of the extent and nature of the lesions. Clinically, VGI typically presents with nonspecific symptoms, including fever, unexplained bacteremia, weight loss, and localized pain. Laboratory findings often reveal elevated inflammatory markers such as white blood cell count, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), but these markers lack specificity. Emerging techniques, such as genetic testing, can significantly enhance pathogen detection rates. Imaging modalities include ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine imaging. CT angiography (CTA)is the preferred imaging modality for suspected VGI, as it provides direct visualization of infection-related features, such as peri-graft gas, fluid collections, and pseudoaneurysms. 18F-FDG PET/CT demonstrates high sensitivity and can reveal metabolic information related to infections, offering important insights for diagnosis and differential diagnosis. The MAGIC (Management of Aortic Graft Infection Collaboration) criteria provide a systematic framework for VGI diagnosis, incorporating major and minor criteria. VGI should be strongly suspected when at least one major criterion or two minor criteria from different categories are met. Integrating imaging findings, laboratory results, and clinical presentations allows for the early identification and diagnosis of VGI, providing a reliable basis for subsequent treatment. Imaging technologies are indispensable for determining the extent of the lesion, guiding surgical planning, and assessing therapeutic outcomes. In the future, advancements in imaging techniques are expected to further enhance the accuracy and efficiency of VGI diagnosis and treatment.

Key words: vascular graft infection (VGI), imaging examination, diagnostic criteria, computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET/CT), serological testing, MAGIC criteria