多层螺旋CT三维重组技术诊断急性阑尾炎56例分析

目的探讨多层螺旋CT(MSCT)三维重组技术(MPR/CPR)在急性阑尾炎诊断中的应用价值。方法回顾分析56例急性阑尾炎患者的MSCT影像资料。结果 56例中,阑尾成像成功率为96%(54/56),诊断正确率为96%(54/56),其中表现为阑尾增粗水肿、管壁增厚者54例,阑尾腔内粪石21例,阑尾周围炎49例,回盲部壁增厚10例,周围脓肿12例,合并盆腔积液37例,2例并发腹膜炎及麻痹性肠梗阻。结论 MSCT三维重组技术能更好地显示阑尾及其周围情况,诊断准确率高。     

多层螺旋CT对急性阑尾炎的诊断价值

目的探讨多层螺旋CT（MSCT）对急性阑尾炎的诊断价值。方法收集临床疑诊和／或经手术和病理证实为急性阑尾炎患者35例，回顾分析其CT表现。结果26例确诊急性阑尾炎病例中主要CT征象有：阑尾肿大24例（92％），阑尾粪石10例（38％），回盲部肥厚12例（46％），阑尾周围炎20例（77％），局限性脓肿2例（8％）。对照手术病理，MSCT诊断急性阑尾炎准确率89％、敏感性92％、特异度74％、阳性预测值92％、阴性预测值71％。结论MSCT显著提高了急性阑尾炎的术前诊断能力，应成为临床首选的影像学检查方法。     

CT平扫对症状不典型急性阑尾炎的诊断价值

目的分析CT平扫对症状不典型急性阑尾炎的诊断价值。方法将收治的52例症状不典型急性阑尾炎患者作为研究对象,采取飞利浦CT机对进行平扫,使用曲面重建法(CRP)、多平面重建法(MPR),分析比较CT平扫对症状不典型急性阑尾炎的诊断价值。结果所有患者均出现不同程度的急性阑尾炎CT表现,出现阑尾增粗肿大34例,占65.38%,表现为阑尾增粗6~15mm,边缘不清晰,阑尾结缔组织和脂肪密度增高;出现盆腔或右下腹炎性改变39例,占75.00%,表现为周围脂肪密度增高,同时伴斑片状、条索状软组织密度影状,其中阑尾周围少量积液7例(13.46%),阑尾区脓肿3例(5.77%),阑尾内能发现高密度粪石影11例(21.53%);出现盲肠末端局限增厚5例,占9.62%。结论对症状不典型急性阑尾炎患者采取腹部CT平扫具有较高的临床诊断价值。     

多层螺旋CT对老年急性阑尾炎患者的诊断价值

目的探讨多层螺旋CT(MSCT)及图像后处理技术对老年急性阑尾炎患者的诊断价值。方法对经手术及病理确诊的70例年龄大于60岁急性阑尾炎患者术前MSCT图像与手术记录及术后病理检查结果进行回顾性分析。结果 70例患者中,MSCT诊断为急性阑尾炎68例,手术及病理确诊70例,其中19例急性单纯型阑尾炎,31例急性化脓性阑尾炎,20例急性坏疽性阑尾炎(6例合并阑尾周围脓肿)。MSCT对老年急性阑尾炎患者的检出率为97.14%。结论 MSCT结合图像后处理技术能较好地显示阑尾炎症及其周围组织改变,对老年急性阑尾炎具有较高的诊断价值。     

MSCT平扫在基层医院诊断儿童不典型急性阑尾炎的价值

目的:探讨多层螺旋CT(MSCT)平扫诊断儿童不典型急性阑尾炎的价值。方法:回顾性收集20例临床表现不典型的儿童急性阑尾炎患儿MSCT影像学资料,并与术中、病理资料进行对照。结果:20例急性阑尾炎患儿均为不典型临床表现,术前MSCT影像:20例患儿均可见阑尾增粗、阑尾壁增厚,其中14例阑尾周围脂肪间隙模糊,12例阑尾内可见积液,6例阑尾穿孔合并周围脓肿形成,10例出现阑尾内粪石。影像资料与临床手术、病理资料进行对照结果一致。结论:MSCT平扫对儿童不典型急性阑尾炎定位及定性诊断有重要临床价值,并可评估其并发症,有利于临床早期制定科学合理治疗方案。     

多层螺旋CT及后处理技术在急性阑尾炎诊断中的价值

目的:探讨多层螺旋CT(MSCT)及图像后处理技术对急性阑尾炎的诊断价值。方法:67例临床拟诊为急性阑尾炎的病例行MSCT检查,并经工作站进行多层面重建(MPR)及曲面重建(CPR)图像后处理,分析其CT表现并与手术病理结果对照。结果:急性阑尾炎MSCT的主要征象有阑尾管腔直径增粗(直径>6mm)、管壁增厚38例,阑尾周围炎31例,阑尾结石19例,回盲部管壁肥厚15例,阑尾脓肿12例,阑尾炎性包块7例。MSCT对急性阑尾炎诊断的敏感性、特异性、准确度、阳性预测值、阴性预测值分别为95%、82%、93%、96%、75%。结论:急性阑尾炎有典型的CT表现。MSCT及图像后处理技术能多方位显示阑尾本身及其周围组织改变及合并症,可显著提高急性阑尾炎的术前诊断准确率。     

多排CT在急性阑尾炎穿孔与非穿孔中的鉴别诊断价值

目的:观察分析多排CT在急性阑尾炎穿孔与非穿孔中的鉴别诊断价值。方法:将我院收治的经手术和病理证实的急性阑尾炎患者74例,按照手术以及病理结果分为穿孔组(n=30)和非穿孔组(n=44),比较2组患者的CT表现。结果:2组患者观察指标比较,穿孔组患者阑尾平均直径显著大于非穿孔组[(13.19±3.48)mm vs.(10.15±2.55)mm,P0.05)];相较于非穿孔性阑尾炎,穿孔性阑尾炎患者更易出现腹膜腔脓肿、蜂窝组织炎、阑尾壁强化伴缺损、阑尾腔内、外积气以及合并附近大肠炎(P0.05)。2组患者阑尾腔内气体和阑尾腔内粪石的CT征象比较,差异无统计学意义;而其他CT征象的比较,穿孔组患者均显著高于非穿孔组患者(P0.05)。各CT征象对穿孔性阑尾炎诊断比较,阑尾腔外粪石、气体等指标的特异性达100%,准确性也分别达60.1%和69.6%,但是其敏感性却分别为8.5%和26.5%,差异有统计学意义(P0.05)。结论:多排CT不仅能够清楚显示阑尾本身、阑尾周围情况以及并发症情况,还能显示阑尾周围邻近脏器的病变情况,对诊断阑尾穿孔有一定价值,是诊断穿孔性阑尾炎最有效、快速的方法。     

急性阑尾炎的多层CT表现及诊断意义

目的：分析急性阑尾炎的多层螺旋CT（MSCT）征象,提高CT对急性阑尾炎诊断的准确性。材料与方法：对126例手术病理证实为急性阑尾炎的腹部多层螺旋CT进行回顾性分析,对阑尾大小、形态、位置及盲肠周围改变进行观察、分析,并把CT征象和手术结果对照。结果：126例中有120例多层螺旋CT诊断正确,CT表现包括直接征象和间接征象。直接征象为阑尾增粗、增大（85.7%）,间接征象包括阑尾周围炎（81.75%）和阑尾盲肠周围脓肿（21.4%）。有6例急性阑尾炎患者CT表现无异常征象。结论：急性阑尾炎的MSCT征象对提高诊断和鉴别诊断能力有很大帮助。     

超声与多层螺旋CT对可疑急性阑尾炎患者的诊断价值探讨

目的:探讨和对比超声和多层螺旋CT(MSCT)对可疑急性阑尾炎患者的临床诊断价值。方法:对我院急诊科收治的335例可疑阑尾炎的患者进行超声和MSCT检查,并与手术病理结果对照,比较2种影像学检查技术的临床诊断价值。结果:MSCT诊断急性阑尾炎的敏感性和阴性预测价值明显高于超声检查(98.0%vs.85.2%,93.8%vs.66.4%,P0.01);MSCT诊断急性阑尾炎阑尾穿孔的敏感性优于超声检查(91.2%vs.67.6%,P0.05)。超声在检测阑尾增粗肿大和阑尾壁充血增厚的敏感性明显低于MSCT(P0.01),且在检测阑尾-盲肠周围炎和阑尾周围脓肿时的敏感性和特异性均明显低于MSCT(P0.01)。结论:多层螺旋CT诊断急性阑尾炎的发生、阑尾穿孔和多种影像学征象的诊断价值明显优于超声检测。     

MSCT对急性阑尾炎病理类型的预测价值

目的评价MSCT对急性阑尾炎病理类型的预测价值。方法回顾性分析112例经手术病理证实的急性阑尾炎患者的MSCT图像,观察急性阑尾炎的CT征象并进行评分;使用Spearman秩相关法对CT征象与病理分型进行相关性分析,筛选出与病理分型显著相关的CT征象,再利用上述征象作为变量进行Logistic回归分析,以预测病理类型,并评价回归模型的预测效果。结果阑尾直径、阑尾石、周围脂肪密度、管腔外积液、管腔内积液、箭头征、右侧腰大肌前缘模糊、盆腔积液、管腔内积气、盲肠条带征、乙状结肠壁增厚11个征象与急性阑尾炎病理分型存在显著相关,Logistic回归分析显示前5个征象可预测阑尾炎病理类型,预测值和病理分型的加权κ值为0.78,Logistic回归模型总体诊断准确率为85.71%(96/112)。结论应用上述5个MSCT征象建立的Logistic回归模型能够准确预测急性阑尾炎患者的病理学类型。     

Beyond appendicitis; radiologic review of unusual and rare pathology of the appendix

Appendicitis is a very common cause of acute abdominal pathology, however, many other pathologic conditions of the appendix can be diagnosed utilizing CT. Examples of these conditions include primary appendiceal neoplasms, secondary inflammation of the appendix, stump appendicitis, endometriosis, appendicitis within a hernia, appendiceal diverticulosis and intussusception and intraluminal foreign bodies. The purpose of this article is to review appendiceal pathology outside of acute appendicitis, describe corresponding imaging findings on CT, and to illustrate various CT findings of appendiceal disease with representative cases.     

64层螺旋CT曲面重建及多平面重建技术对急性阑尾炎的诊断价值

目的：探讨64层螺旋CT多平面重建及曲面重建技术对急性阑尾炎的诊断价值。方法：回顾性分析60例行64层螺旋CT检查并经病理证实的急性阑尾炎病例。将常规扫描读片结合多平面重建、曲面重建的读片结果与常规横断位阅片结果进行对比分析,比较两者在诊断急性阑尾炎中的差异。结果：64层螺旋CT多平面重建及曲面重建联合应用阑尾显示率达到100％（60／60）,阑尾外径增大、阑尾壁增厚的显示率也明显提高。结论：联合应用64层螺旋CT多平面重建及曲面重建可以更准确地识别阑尾,从而提高阑尾炎诊断的准确率。     

急性阑尾炎的CT表现

目的 探讨急性阑尾炎的CT表现。方法 对68例手术、病理证实为急性阑尾炎病人的腹部CT资料进行回顾性分析，对阑尾大小、有无阑尾结石、阑尾周围及盲肠末端的改变作了观察、分析。结果 68例中61例CT诊断为急性阑尾炎，7例假阴性，CT诊断急性阑尾炎的敏感性为89．7％。急性阑尾炎的CT表现主要有阑尾增粗(76．5％)，阑尾结石(29．4％)，阑尾周围炎性改变(66．2％)，阑尾脓肿(13．2％)，蜂窝织炎(10．3％)，盲肠末端肠壁增厚(7．4％)和局部淋巴结肿大(5．9％)。结论 急性阑尾炎可出现多种CT表现，熟悉这些表现有助于提高CT诊断阑尾炎的准确性。     

CT诊断高位急性阑尾炎

目的 分析高位急性阑尾炎的临床表现和CT特征,探讨CT诊断高位急性阑尾炎的价值.方法 回顾性分析经手术证实和临床、CT随访证实的高位急性阑尾炎21例.采用16排CT扫描机进行急诊腹部平扫检查,扫描范围分别为上腹、上中腹、中下腹和全腹.由2名放射科医师分别对图像进行分析.结果 21例中,14例(14/21,66.67%)...     

多排螺旋CT诊断急性阑尾炎的价值分析

目的分析急性阑尾炎多排螺旋CT表现并探讨多排螺旋CT（MSCT）对急性阑尾炎诊断价值。方法回顾性分析15例经手术病理证实的急性阑尾炎及阑尾炎并发症的MSCT表现及分型,采用16排CT对全腹部进行多期扫描,利用多平面重组（MPR）、曲面重组（CPR）及最大密度投影（MIP）等后处理技术进行观察。结果急性化脓性阑尾炎3例,急性坏疽穿孔性阑尾炎及阑尾脓肿12例,发生并发症10例,并发症均发生于阑尾坏疽穿孔或阑尾溶解病例,其中盆腔脓肿4例,腹腔脓肿3例,盆腔、腹腔均见脓肿1例,粘连性肠梗阻4例,腹腔脓肿伴输尿管炎性狭窄1例,阑尾脓肿累及盆腹壁致腹壁瘘、合并肓肠癌1例。术前14例正确诊断急性化脓性阑尾炎或阑尾脓肿,CT诊断率达93．3％。但急性化脓性阑尾炎与急性坏疽性阑尾炎无穿孔时鉴别困难。结论急性阑尾炎MSCT表现具有一定特征性,对急性阑尾炎诊断具有重要价值。     

Appendiceal enlargement as a criterion for clinical diagnosis of acute appendicitis: is it reliable and valid?

The purpose of this study was to evaluate appendiceal enlargement as a radiographic criterion for the diagnosis of acute appendicitis. We examined medical records and specimens of 190 adults and children who presented to a teaching hospital in New York City with right-lower-quadrant pain and who underwent surgery. Computed tomography (CT), clinical evaluation (based on Alvarado's predictive model) and pathologic data of these 190 cases revealed that appendiceal enlargement might in some cases represent a normal anatomic variant of a vermiform appendix and that the lack of a dilated lumen and thickened wall did not necessarily establish the absence of inflammation. Yet, radiologic evidence of appendix size often influences the diagnosis and management of patients with acute abdominal pain, including the decision to operate. This tendency to equate an enlarged appendix with appendicitis is shown to lead to an inappropriate diagnosis and jeopardize optimal care of patients with acute abdominal pain.     

Differentiation of early perforated from nonperforated appendicitis: MDCT findings,MDCT diagnostic performance,and clinical outcome

To determine the CT findings and assess their diagnostic performance in differentiating early perforated appendicitis from nonperforated appendicitis, and to compare therapeutic approaches and clinical outcomes between two types of appendicitis. Our retrospective study was approved by our institutional review board and informed consent was waived. From July 2012 to July 2013, 339 patients [mean age 40.8 years; age range 19–80 years; 183 male (mean age 40.5 years; age range 19–79 years) and 156 female (mean age 41.2 years; age range 19–80 years)] who underwent appendectomy with preoperative CT examination for suspected acute appendicitis were included, with exclusion of 37 patients with specific CT findings for advanced perforated appendicitis. And they were categorized into nonperforated and early perforated appendicitis groups according to surgical and pathologic reports. The following CT findings were evaluated by two radiologists blinded to pathologic and surgical findings: transverse diameter of the appendix, thickness of the appendiceal wall, the depth of intraluminal appendiceal fluid, appendiceal wall enhancement, presence or absence of focal defect in the appendiceal wall, intraluminal appendiceal air, appendicolith/fecalith, periappendiceal changes, cecal wall thickening, and free fluid. The type of surgical procedures, performance of surgical drainage, and the length of hospital stay were recorded. Univariate and multivariate logistic regression analysis were used to determine the CT findings for differentiating early perforated appendicitis from nonperforated appendicitis, a total of 75 (22%) of the 339 patients was diagnosed with early perforated appendicitis. Focal wall defect [adjusted odds ratio (aOR), 23.40; p < 0.001], circumferential periappendiceal changes (aOR, 5.63; p < 0.001), appendicoliths/fecaliths (aOR, 2.47; p = 0.015), and transverse diameter of the appendix (aOR, 1.22; p = 0.003) were independently differentiating variables for early perforated appendicitis. The transverse diameter of the appendix (≥11 mm) had the highest sensitivity (62.7%) and focal wall defect in the appendiceal wall showed the highest specificity (98.8%). The prevalence of surgical drainage was higher (p = 0.001) and the mean hospital stay was approximately one day longer (p < 0.001) in the early perforated group than nonperforated group. CT can be helpful in differentiating early perforated appendicitis from nonperforated appendicitis, although the sensitivity of the evaluated findings was somewhat limited.     

48例不典型急性阑尾炎的ct诊断价值

目的:探讨不典型急性阑尾炎的CT诊断价值.材料与方法:对48例不典型急性阑尾炎的病人行多层螺旋CT检查分析,并与手术病理对照.结果:48例不典型急性阑尾炎的病人CT征象有:45例阑尾显示异常.表现为阑尾局部肿胀,阑尾壁增粗,增粗阑尾管腔呈实性状.肿胀阑尾境界不清,伴有回盲部的炎性渗出,有的伴有阑尾壁为不同密度分层的同心圆改变,回盲部软组织肿,呈斑点状或条纹状密度增高改变.螺旋CT对不典型急性阑尾炎诊断准确率为93.75％.结论:螺旋CT检查是目前诊断不典型急性阑尾炎的较佳方法.     

阑尾炎术前MSCT重组显示的临床价值

目的 探讨阑尾炎术前MSCT检查的临床价值.方法 回顾性分析经手术病理证实的99例疑似阑尾炎病例,男57例,女42例,年龄3～82岁.术前均行常规盆腔CT扫描和冠状、矢状、平行髂骨和垂直髂骨四个方位的MPR重建.结果 90例能够清楚显示阑尾,9例因阑尾周围脓肿不能显示,阑尾显示率90.9%（90/99）.阑尾直径6.2～26.6 mm,平均14.0 mm.显示阑尾的最佳截面：冠状位59例,矢状位19例,垂直髂骨7例,平行髂骨4例,轴位1例.阑尾位置：回肠后位30例,盲肠后位6例,回肠前位11例,盲肠前位4例,盲肠下位39例.阑尾梗阻部位：根部86例,中间4例;其中可见明确粪石43例,未见明确粪石47例.阑尾周围炎性浸润56例,无炎性浸润30例,脓肿形成13例.结论 多层螺旋CT重组有利于清楚显示阑尾,对术前阑尾炎准确诊断和定位有相当大的临床价值.