A Retrospective Case-Control Study to Evaluate the Diagnostic Accuracy of Honeycomb Sign in Melioid Liver Abscess

Area of Science:

• Medical Imaging
• Infectious Diseases
• Hepatology

Background:

• Melioidosis is a serious infection endemic in certain regions, often presenting as pyogenic liver abscesses.
• Identifying melioid liver abscesses is crucial for timely and appropriate treatment, especially in at-risk populations.
• The "honeycomb sign" on imaging has been suggested as a characteristic feature of melioid liver abscess.

Purpose of the Study:

• To investigate the incidence, sensitivity, and specificity of the "honeycomb sign" in culture-proven melioid liver abscesses.
• To evaluate the diagnostic performance of the "honeycomb sign" in comparison to other imaging features.
• To assess the interobserver agreement for the "honeycomb sign" among radiologists.

Main Methods:

• A retrospective case-control study analyzing 40 abscesses from patients with culture-proven melioidosis.
• Abscesses ≥ 2 cm were assessed for the presence of the "honeycomb sign" by two radiologists.
• Statistical analysis included calculating sensitivity, specificity, positive predictive value, and negative predictive value, with P < 0.05 considered significant.

Main Results:

• The "honeycomb sign" was present in 85% of melioid liver abscesses, demonstrating high sensitivity (85%) and good specificity (75%).
• Interobserver agreement for the "honeycomb sign" was substantial (kappa = 0.70 and 0.92).
• For abscesses ≥ 3 cm, sensitivity increased to 91% with maintained specificity.

Conclusions:

• The "honeycomb sign" is a valuable imaging marker for melioid liver abscess.
• Increased radiologist awareness of this sign can improve the diagnosis and management of melioidosis.
• This imaging feature holds potential to influence clinical decision-making in endemic regions.