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. 2022 Feb 14;12(2):493.
doi: 10.3390/diagnostics12020493.

Imaging and Clinical Parameters for Distinction between Infected and Non-Infected Fluid Collections in CT: Prospective Study Using Extended Microbiological Approach

Christopher Skusa  1 , Romy Skusa  2 , Moritz Wohlfarth  1 , Philipp Warnke  2 , Andreas Podbielski  2 , Kristina Bath  1 , Justus Groß  3 , Clemens Schafmayer  3 , Hagen Frickmann  2   4 , Marc-André Weber  1 , Andreas Hahn  2 , Felix G Meinel  1
Affiliations

Imaging and Clinical Parameters for Distinction between Infected and Non-Infected Fluid Collections in CT: Prospective Study Using Extended Microbiological Approach

Christopher Skusa et al. Diagnostics (Basel). .

Abstract

The aim of this investigation was to evaluate predictive CT imaging features and clinical parameters to distinguish infected from sterile fluid collections. Detection of infectious agents by advanced microbiological analysis was used as the reference standard. From April 2018 to October 2019, all patients undergoing CT-guided drainages were prospectively enrolled, if drainage material volume was at least 5 mL. Univariate analysis revealed attenuation (p = 0.001), entrapped gas (p < 0.001), fat stranding (p < 0.001), wall thickness (p < 0.001) and enhancement (p < 0.001) as imaging biomarkers and procalcitonin (p = 0.003) as clinical predictive parameters for infected fluid collections. On multivariate analysis, attenuation > 10 HU (p = 0.038), presence of entrapped gas (p = 0.027) and wall enhancement (p = 0.028) were independent parameters for distinguishing between infected and non-infected fluids. Gas entrapment had high specificity (93%) but low sensitivity (48%), while wall enhancement had high sensitivity (91%) but low specificity (50%). CT attenuation > 10 HU showed intermediate sensitivity (74%) and specificity (70%). Evaluation of the published proposed scoring systems did not improve diagnostic accuracy over independent predictors in our study. In conclusion, this prospective study confirmed that CT attenuation > 10 HU, entrapped gas and wall enhancement are the key imaging features to distinguish infected from sterile fluid collections on CT.

Keywords: CT; abscess; attenuation; drainage; gas entrapment; infection; wall enhancement.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
An 83-year-old woman with chambered pleural effusion (→) and CT attenuation of 8 HU. After percutaneous drainage, no pathogen was detected by microbiological approach.
Figure 2
Figure 2
A 63-year-old man with presacral abscess (*), demonstrating gas entrapment (→), wall enhancement (>), fat stranding and CT attenuation of 29 HU. Microbiology after percutaneous drainage confirmed infection.
Figure 3
Figure 3
ROC curve for statistically significant parameters in multivariate regression analysis to identify microorganism-containing fluid collections applied to our cohort (n = 86).
Figure 4
Figure 4
ROC curve for published scoring systems to identify microorganism-containing fluid collections, applied to our cohort.
See this image and copyright information in PMC

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