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Incorporation versus infection of retroperitoneal aortic grafts: MR imaging features
W Auffermann1, P A Olofsson, G N Rabahie
1Department of Radiology, University of California, San Francisco 94143.
Abstract:
The magnetic resonance (MR) imaging characteristics of normal aortic graft healing were compared with those of perigraft infection in 57 patients after aortic graft implantation. Thirty-three patients without postoperative complications underwent MR imaging in a 0.35-T unit 1 week after graft implantation, and 13 of those patients were reexamined 2-3 months after graft implantation. Twenty-four patients with clinically suspected perigraft infection underwent MR imaging 6 weeks to 18 years after graft implantation. Early normal postoperative changes were characterized by a perigraft collar of low to medium signal intensity on T1-weighted images and of high intensity on T2-weighted images in all 33 cases, consistent with perigraft fluid collection. In 10 of 13 patients reexamined 2-3 months postoperatively, the MR images demonstrated a collar of tissue consistent with perigraft fibrosis. In cases of clinical suspicion of retroperitoneal graft infection, MR imaging showed eccentric fluid collections of low to medium signal intensity on T1-weighted images and high intensity on T2-weighted images at more than 3 months after surgery. The MR findings were diagnostic of retroperitoneal perigraft infection in 17 of 20 patients shown to be infected at surgery. Retroperitoneal infection was correctly excluded on the basis of MR findings in four patients. Thus, MR imaging is an accurate imaging method for the diagnosis of aortic graft infection. In the early postoperative phase, resolving perigraft fluid cannot be differentiated from perigraft infection.
Insights
Magnetic resonance (MR) imaging accurately diagnoses aortic graft infections by analyzing perigraft fluid and tissue changes. Early postoperative imaging may not differentiate healing from infection.
Area of Science:
- Radiology
- Medical Imaging
- Surgical Complications
Background:
- Aortic graft implantation is a common procedure.
- Perigraft infection is a serious complication following aortic graft surgery.
- Differentiating normal healing from infection is crucial for patient management.
Purpose of the Study:
- To compare magnetic resonance (MR) imaging characteristics of normal aortic graft healing with perigraft infection.
- To evaluate the diagnostic accuracy of MR imaging in detecting aortic graft infections.
Main Methods:
- Retrospective analysis of MR imaging in 57 patients post-aortic graft implantation.
- Utilized a 0.35-T MR unit for imaging.
- Compared early postoperative changes (1 week, 2-3 months) with later findings in suspected infection cases (6 weeks to 18 years).
Main Results:
- Early MR imaging showed perigraft fluid collections in normal healing.
- Later MR imaging revealed perigraft fibrosis in uncomplicated cases.
- MR imaging identified characteristic fluid collections in 17 of 20 confirmed infections and excluded infection in 4 patients.
- Early postoperative imaging could not differentiate resolving fluid from infection.
Conclusions:
- Magnetic resonance (MR) imaging is an accurate method for diagnosing aortic graft infections.
- MR imaging findings can help differentiate between normal graft healing and infection, particularly in later postoperative stages.
- Distinguishing early postoperative fluid from infection requires careful interpretation.