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Computed tomography improves the differentiation of infectious mediastinitis from normal postoperative changes after sternotomy in cardiac surgery

  • Borek Foldyna
  • Martin Mueller
  • Christian D. Etz
  • Christian Luecke
  • Josephina Haunschild
  • Ines Hoffmann
  • Matthias Gutberlet
  • Lukas Lehmkuhl
Chest
  • 17 Downloads

Abstract

Objectives

To identify CT parameters independently associated with infectious mediastinitis after cardiac surgery and to improve the discrimination of patients with acute infection from those with normal postoperative changes.

Methods

In this single-center, retrospective, observational cohort study, we evaluated thoracic CT scans of poststernotomy cardiac surgery patients. Inclusion criteria were clinically suspected mediastinitis, unclear CT signs (e.g., retrosternal mass), and subsequent deep revision surgery. Revision surgery and microbiological samples determined the mediastinitis status. Overall, 22 qualitative and quantitative CT imaging parameters were assessed and associated with infectious mediastinitis in univariate and multivariate regression models. Discriminative capacity and incremental value of the CT features to available clinical parameters were determined by AUC and likelihood-ratio tests, respectively.

Results

Overall 105 patients (82% men; 67.0 ± 10.3 years) underwent CT and deep revision surgery. Mediastinitis was confirmed in 83/105 (79%) patients. Among available clinical parameters, only C-reactive protein (CRP) was independently associated with infectious mediastinitis (multivariate odds ratio (OR) (per standard deviation) = 2.3; p < 0.001). In the CT, the presence of free gas, pleural effusions, and brachiocephalic lymph node size were independently associated with mediastinitis (multivariate ORs = 1.3–6.3; p < 0.001–0.039). Addition of these CT parameters to CRP increased the model fit significantly (X2 = 17.9; p < 0.001; AUC, 0.83 vs. 0.73).

Conclusion

The presence of free gas, pleural effusions, and brachiocephalic lymph node size in CT is independently associated with infectious mediastinitis in poststernotomy patients with retrosternal mass. These imaging features may help to differentiate mediastinitis from normal postoperative changes beyond traditional clinical parameters such as CRP.

Key Points

Presence of free gas, pleural effusions, and brachiocephalic lymph node size on CT are associated independently with infectious mediastinitis.

• Combination of these CT parameters increases the discriminatory capacity of clinical parameters such as CRP.

Keywords

Multidetector computed tomography Mediastinitis Sternotomy Cardiac surgery 

Abbreviations

CRP

C-reactive protein

HU

Hounsfield unit

ICC

Intra-class correlation coefficient

IQR

Inter-quartile range

Ln

Lymph node

OR

Odds ratio

ROI

Region of interest

SD

Standard deviation

VOI

Volume of interest

Notes

Acknowledgments

BF received unrelated funding from the German Research Foundation (DFG) project 290004377 (FO 993/1).

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Dr. Matthias Gutberlet.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise. No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

Supplementary material

330_2018_5946_MOESM1_ESM.docx (3.8 mb)
ESM 1 (DOCX 3918 kb)

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyUniversity of Leipzig – Heart CenterLeipzigGermany
  2. 2.Cardiac MR PET CT ProgramMassachusetts General Hospital – Harvard Medical SchoolBostonUSA
  3. 3.Department of Cardiac SurgeryUniversity of Leipzig – Heart CenterLeipzigGermany
  4. 4.MVZ Laboratory Reising-Ackermann MD and ColleaguesLeipzigGermany
  5. 5.Clinic for RadiologyCardiovascular Center Bad NeustadtBad NeustadtGermany

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