Clinical Value Of Contrast-Enhanced Ultrasound In Interventional Diagnosis And Treatment Of Klebsiella Pneumoniae Liver Abscess

Objective: The purpose of this study was to analyze the imaging features of contrast-enhanced ultrasound(CEUS)of klebsiella pneumoniae liver abscesses(KPLA)and non-klebsiella pneumoniae liver abscesses(NKPLA).Combined with percutaneous catheter drainage(PCD)for the treatment of liver abscess,the extracted pus was subjected to bacterial culture to explore the clinical value of CEUS in the differential diagnosis of the two,and further analyze the clinical value of CEUS in KPLA interventional therapy.Methods: A total of 122 patients who received PCD in our hospital from August 2018 to November 2022 and were confirmed as liver abscess by bacterial culture or blood culture were selected as the study subjects.There were 77 males and 45 females,aged from 14 to 84 years old,with an average of(58.85±12.56)years old.According to the type of PLA pathogenic bacteria,they were divided into KPLA group and NKPLA group,including 80 cases in KPLA group and 42 cases in NKPLA group.Firstly,the clinical features,two-dimensional ultrasound features and CEUS of patients in KPLA group and NKPLA group were analyzed.The clinical features included general data(gender,age),common clinical symptoms and concomitant diseases including fever,abdominal pain,history of biliary system and metastatic infection.Two-dimensional ultrasound features included the number of lesions,lesion diameter,and lesion location;the characteristics of CEUS included the thickness of the lesion wall,the degree of enhancement around the lesion,the gas contained in the lesion,and the separation enhancement in the lesion.The extraction time and hospitalization time of the two groups of patients after PCD were analyzed.The single variable of KPLA group and NKPLA group was identified by analysis,and then the variables with differences were included in the multivariate Logistic regression analysis to obtain the single independent influencing factor of the differential diagnosis between the two groups.Finally,the receiver operating characteristic curve(ROC)was constructed,and the area under the curve(AUC)was calculated to analyze the diagnostic value of single independent influencing factor and the combination of the three in the differential diagnosis of KPLA and NKPLA.Results:1.Univariate analysis showed that there was no significant difference between KPLA group and NKPLA group in gender,age,fever,abdominal pain,number of lesions,diameter of lesions,location of lesions,diabetes mellitus,gas in lesions and enhancement of septa in lesions(P>0.05).2.The thickness of the lesion wall,the degree of enhancement around the lesion,whether there is a history of biliary system,and whether there is a metastatic infection in the KPLA group and the NKPLA group were statistically significant(P<0.05).Compared with NKPLA,the KPLA group had no history of biliary tract system(67.50% vs 42.86%,P=0.009),with metastatic infection(60.00% vs 30.95%,P=0.002),thin-walled lesions(77.50% vs 30.95%,P<0.001),and equal enhancement around the lesion(64.63% vs 47.61%,P=0.046).The above statistically significant single variables were included in the multivariate Logistic regression model.The results suggested that the thickness of the lesion wall,the history of the biliary system,and the metastatic infection were the independent influencing factors for the identification of KPLA and NKPLA(P<0.05).3.The ROC curve was constructed by using the above single independent influencing factors and the combined application of the three as diagnostic indicators.The results showed that the AUC of the combined application of the three was higher than that of the three single independent influencing factors of lesion wall thickness,history of biliary system and metastatic infection.The AUC were 0.820(95%CI:0.740～0.899)vs 0.733(95%CI:0.635～0.830),0.623(95%CI:0.517～0.729),0.645(95%CI:0.543～0.748).4.KPLA group and NKPLA group were all successfully punctures in one time after PCD,and there were no complications such as pneumothorax,bile leakage,infection and bleeding during and after surgery.The hospitalization time of KPLA group was shorter than that of NKPLA group,and the comparison between the two groups was statistically significant(15.22±4.25 vs 23.21±4.92,P<0.001),but there was no statistically significant difference in extraction time between the two groups(12.14±4.09 vs 13.19±4.36,P=0.189).Conclusion: The imaging features and clinical data of CEUS in hepatic abscess have good clinical value in the differential diagnosis of KPLA and NKPLA.Most patients in KPLA group had no history of biliary system,and most lesions were thin-walled and may be accompanied by metastatic infection.If the liver abscess patient has a history of biliary system and the lesion is thick-walled without metastatic infection,NKPLA is highly likely.This can be of certain reference value for clinicians to choose the direction of antibiotics before the results of blood culture or bacterial culture are known.The treatment of liver abscess with PCD has little trauma,low cost and high patient acceptance.Accurate localization of liver abscess by CEUS and avoidance of surrounding important organs can help reduce bleeding risk and improve the success rate of puncture catheters,which can be widely used in clinical practice.