穿孔性阑尾炎CT征象

目的 探讨阑尾穿孔具有诊断价值的CT征象。方法 回顾性分析205例经手术病理证实的穿孔性和非穿孔性阑尾炎患者的CT图像。观察12项急性阑尾炎的CT征象,采用χ²检验筛选可用于鉴别诊断穿孔性与非穿孔性阑尾炎的CT征象,评价这些征象的敏感度、特异度和准确率。采用Logistic回归分析法分析阑尾穿孔最具诊断价值的CT征象。结果 205例中,40例(40/205,19.51%)阑尾穿孔与165例(165/205,80.49%)阑尾未穿孔患者间,脓肿、阑尾壁强化缺损、蜂窝织炎、阑尾腔外积气、阑尾腔外粪石差异均有统计学意义(P均<0.05),各征象鉴别诊断穿孔性和非穿孔性阑尾炎的敏感度、特异度和准确率依次分别为:脓肿80.00%(32/40)、97.58%(161/165)、94.15%(193/205),阑尾壁强化缺损50.00%(20/40)、98.79%(163/165)、89.27%(183/205),蜂窝织炎37.50%(15/40)、95.76%(158/165)、84.39%(173/205),阑尾腔外积气27.50%(11/40)、99.39%(164/165)、85.37%(175/205),阑尾腔外粪石5.00%(2/40)、100.00%(165/165)、81.46%(167/205),Logistic回归分析显示脓肿、阑尾壁强化缺损与阑尾穿孔相关(Wald=33.21、16.19,P均<0.001)。结论 脓肿、阑尾壁强化缺损是阑尾穿孔最有诊断价值的CT征象。     

Sonography for appendicitis: Nonvisualization of the appendix is an indication for active clinical observation rather than direct referral for computed tomography

PURPOSE.: To determine the prevalence of perforated and nonperforated appendicitis in patients with nonvisualization of the appendix on ultrasound (US) performed for suspected appendicitis, and to evaluate the value of CT in these patients. METHODS.: We analyzed 400 consecutive patients undergoing US for suspected appendicitis. Of these patients, 260 had nonvisualization of the appendix, but otherwise normal scans. We analyzed the clinical outcome in these patients to determine the prevalence of appendicitis, referrals for CT, and the contribution of CT in these patients. RESULTS.: Of the 400 patients, 140 (35%) had either a normal (80 patients, 25%) or an abnormal appendix (60 patients, 15%); 260 (65%) had nonvisualization of the appendix. Overall 75 patients had appendicitis (18.8%) and 17 (4.3%) had appendicitis with perforation. Of the 260 patients with nonvisualization of the appendix, 14 patients (5.4%) had appendicitis and 2 were perforated (0.8%). The prevalence of perforated and nonperforated appendicitis in this group was significantly lower than the overall group (p < 0.001 and p < 0.01, respectively). Of these 260 patients, 101 patients (38.8%) had CT within 48 hours and 79 (78.2%) had normal scans. CONCLUSIONS.: Patients with nonvisualization of the appendix on US, but otherwise normal scans, are at significantly lower risk for appendicitis, either perforated or nonperforated. Active clinical observation should be considered in these patients, rather than direct referral for CT. ? 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:455-461,2012.     

穿孔性阑尾炎的临床表现及CT表现

目的 比较穿孔性和非穿孔性阑尾炎的CT及临床表现,探讨CT对穿孔性阑尾炎的诊断价值.方法 术后回顾性分析109例阑尾炎患者,将其分为穿孔性阑尾炎和非穿孔性阑尾炎2组,分析及比较二组临床症状、体征、实验室检查及CT征象.结果 症状持续超过3d、右下腹痛性包块,CT上阑尾管壁缺损、阑尾周围积气、阑尾腔外结石、腹腔脓肿、蜂窝组织炎等对于穿孔性阑尾炎的诊断具有较大的特异性,而反跳痛、腹肌紧张及CT上阑尾直径、阑尾周围肠壁增厚在穿孔性阑尾炎组中出现的概率也高于非穿孔性阑尾炎组(P＜0.05).结论 结合CT征象及临床表现可提高穿孔性阑尾炎的诊断,对于手术方案的选择具有较大的意义.     

Ischemia-modified albumin as a predictor of the severity of acute appendicitis

Background: The early prediction of gangrenous/perforated appendicitis is of great importance for the surgical planning, further treatments, and predicting the course of disease. Ischemia-modified albumin (IMA) was previously reported as a biomarker of various ischemia-based diseases. Our aim is to determine the predictive value of serum IMA in the severity of acute appendicitis. Methods: Sixty-two patients who underwent urgent appendectomy were included in the study. Plasma level of IMA was measured after diagnosis and before treatment. All patients were classified as noncomplicated (acute) appendicitis and complicated (gangrenous/perforated) appendicitis according to histopathological findings, and comparisons were made between the groups. Results: The data of 62 patients with a mean age of 30.1 years were statistically evaluated. The pathological diagnoses were acute appendicitis in 33 (53.2%), and gangrenous/perforated appendicitis in 29 (46.8%) patients. There were significant differences in computed tomography (CT) findings (P = .031) and IMA (P = .012) levels between the groups. A strong positive correlation between IMA levels and CT findings was also found (Spearman ρ = +0.688, P = .003). Conclusions: The IMA can be considered as a novel and useful marker to distinguish gangrenous/perforated appendicitis from noncomplicated appendicitis. The correlation of IMA with CT findings also enhances the predictive value of IMA.     

Sonography of acute appendicitis in childhood: perforation versus nonperforation.

We evaluated the sonographic findings in 133 consecutive children referred for suspected appendicitis. Fifty-eight of these patients (44%) ultimately underwent surgery, with 54 of these proved to have acute appendicitis. Thirty-one (58%) of the 54 had nonperforated appendicitis, and 23 (43%) had evidence of perforation. Previously described sonographic findings that have been employed in the diagnosis of appendicitis were evaluated, with the presence or absence of these findings being compared in patients with non-perforated and perforated appendicitis. In those patients who did not undergo surgery, the following findings were documented and compared to the findings in patients with proved appendicitis: (1) an identifiable appendix and its sonographic characteristics, (2) fluid localized to the right peritoneal reflection or periappendiceal region, or both, (3) free pelvic fluid, and (4) right lower quadrant adenopathy. Our results suggest that high-resolution, real-time sonography, using graded compression, is very sensitive in the identification of acute nonperforated appendicitis. Perforated appendicitis, however, can be a more difficult diagnosis because the appendix frequently decompresses with perforation and yet may not "wall off" or form a well-defined abscess. As a result, the appendix can be very difficult to identify.     

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。     

Granulomatous appendicitis presenting as right lower quadrant pain: CT findings

Background: We present the computed tomographic (CT) findings of granulomatous appendicitis. Methods: Five of 652 (0.9%) patients who had undergone appendectomy for clinically suspected acute appendicitis over a 19-month period proved to have granulomatous appendicitis. One patient had surgery based on a clinical diagnosis of acute appendicitis. Four patients (three men and one woman; age range = 14–39 years) underwent abdominal CT. The CT findings were retrospectively reviewed with special attention to the appendiceal abnormalities. Results: All four patients presented with subacute clinical presentation. Enlarged appendices of 4.5 and 2 cm in diameter with thickened walls of soft tissue density were found in two patients, and periappendicular inflammatory masses were found in the other two. Enlarged mesenteric lymph nodes and right lower quadrant fat stranding was seen in all four patients. Histopathology showed numerous granulomas within the inflamed appendix. Conclusion: Radiologists should be familiar with the rare entity of granulomatous appendicitis in patients examined by CT for suspected acute appendicitis. An insidious clinical presentation with CT findings of an exceptionally large appendix and associated periappendiceal inflammatory changes should raise the possibility of granulomatous appendicitis or carcinoma or lymphoma of the appendix.     

超声在诊断可疑急性阑尾炎中的作用

目的　探讨超声检查在诊断可疑急性阑尾炎患者中的作用。方法　 35 6例临床怀疑急性阑尾炎患者接受超声检查。采用腹前壁逐级加压探查法 ,在患者感觉最敏感点 ,寻找阑尾。或采用从侧腹向回盲部移动探头寻找阑尾。结果　35 6例临床怀疑急性阑尾炎中 ,超声确诊并被证实的急性阑尾炎有 189例 ( 5 3 % ) ,右侧输尿管结石 2 3例 ( 6 % ) ,妇科疾患者5 6例 ( 16 % ) ,阴性声像图表现者 88例 ( 2 5 % )。其声像图特征 :阑尾壁厚度范围为 2 .0～ 12 .0mm ,平均范围为 ( 5 .0± 1.2 )mm ,阑尾最大前后径 (外径 )为 4.0～ 2 7.0mm ,平均范围为 ( 5 .6± 1.1)mm。其中 4～ 6mm者 5 2例 ,>6mm者 12 7例 ,阑尾周围脂肪组织回声减低 ,有不规则低或无回声者有 2 9% ( 5 5 /189) ,阑尾周围探及淋巴结肿大者有 12 % ( 2 3/189) ,右下腹肠管液体淤积、肠蠕动加快者有 73 % ( 138/189) ,彩色多普勒超声显示阑尾壁的血供丰富者 86 % ( 16 3/189)。阑尾穿孔者 6例 ,阑尾周围脓肿者 4例。结论　急性阑尾炎时 ,超声能判断阑尾肿大程度 ,阑尾位置 ,以及其他重要并发症等。     

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.     

正常阑尾的多排螺旋CT研究

目的：分析正常阑尾的多排螺旋CT表现,提高阑尾早期病变的诊断能力。方法：入选100例经临床诊断排除阑尾炎、阑尾手术史及阑尾其他疾病的患者,采用多排螺旋CT行腹部扫描,准直0．6mm或1．2mm,在工作站上对阑尾进行多平面重建（MPR）、曲面重建（CPR）;测量阑尾直径、阑尾壁厚度、阑尾腔内液体的最大直径,并观察阑尾腔内有无粪石、气体,阑尾周围表现。结果：100例患者中,cT显示阑尾95例,敏感性为95％。正常阑尾直径3～10mm。平均为6．3±1．1mm。直径大于6mm者52例（52％）;阑尾壁厚度1～4mm,平均为2．6±0．5mm,大于3mm者25例（25％）。阑尾腔内有液体者17例,其中,直径大于2．6mm者2例;阑尾腔内有气体者58例（58％）;阑尾腔内有粪石者22例（22％）。阑尾壁钙化者14例（14％）。未见阑尾周围脂肪内出现条索状密度影。结论：多排螺旋CT阑尾重建能清晰地显示阑尾正常结构,有助于阑尾早期病变的诊断。     

阑尾粪石征在急性阑尾炎CT诊断中的价值

目的探讨阑尾粪石征在多层螺旋CT(MSCT)诊断急性阑尾炎中的价值。方法回顾性分析60例经手术和病理证实的急性阑尾炎患者的CT表现。结果 60例急性阑尾炎患者中主要的CT征象有:阑尾粪石征36例(60.0%),阑尾肿胀伴阑尾周围炎(无阑尾粪石征)15例(25.0%),回盲部周围炎6例(10.0%),阑尾炎伴盲肠周围脓肿形成3例(5.0%),提示穿孔1例。所有患者均行急诊阑尾切除术,术后病理诊断为急性阑尾炎。结论阑尾粪石征在MSCT对急性阑尾炎的影像诊断中有着十分重要的意义。     

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%)...     

Crohn’s disease: multi-detector row CT-enteroclysis appearance of the appendix

The objective of our retrospective study was to determine the MDCT-enteroclysis appearance of the appendix in patients with Crohn’s disease and to correlate this appearance with the status of the disease. We reviewed the MDCT-enteroclysis examinations of 76 patients with Crohn’s disease. Images were analyzed for visualization of the appendix, largest axial diameter of the appendix and degrees of enhancement. Findings were correlated with the status of the disease (active vs. nonactive) and compared with those observed in a control group. Among the various variables, hyperenhancement of the appendiceal wall was found in 18.9% of patients with active disease and in no patients with inactive disease nor in the control group (P = 0.0023). This sign had a specificity of 100% for differentiating between active and inactive Crohn’s disease. We conclude that increased appendiceal wall enhancement is, at a statistically significant level, more frequently observed in patients with active Crohn’s disease by comparison with patients with inactive disease and control subjects. This result suggests that this finding may be used as an additional MDCT-enteroclysis finding to determine the activity of the disease.     

Comparison of filtered back projection and iterative reconstruction in diagnosing appendicitis at 2-mSv CT

Purpose

To compare radiologists’ diagnostic performance and confidence, and subjective image quality between filtered back projection (FBP) and iterative reconstruction (IR) at 2-mSv appendiceal CT.

Methods

The institutional review board approved this retrospective study and waived the requirement for informed consent. We included 107 adolescents and young adults (age, 29.8 ± 8.5 years; 64 females) undergoing 2-mSv CT for suspected appendicitis. Appendicitis was pathologically confirmed in 42 patients. Seven readers with different experience levels independently reviewed the CT images reconstructed using FBP and IR (iDose⁴, Philips). They rated both the likelihood of appendicitis and subjective image quality on 5-point Likert scales. Diagnostic confidence was assessed using the likelihood of appendicitis, proportion of indeterminate interpretations, and 3-point normal appendix visualization score. We used receiver operating characteristic analyses, Wilcoxon’s signed-rank tests, and McNemar’s tests.

Results

The pooled area under the receiver operating characteristic curve (AUC) was 0.96 for both FBP and IR (95% CI for the difference, ?0.02, 0.02; P = 0.73). The AUC difference was not significant in any of the individual readers (P ≥ 0.21). For the majority of the readers, the diagnostic confidence was not significantly different between the two reconstruction methods. Subjective image quality tended to be higher with IR for all readers (P ≤ 0.70), showing significant differences for four readers (P ≤ 0.040).

Conclusion

When diagnosing appendicitis at 2-mSv CT in adolescents and young adults, FBP and IR were comparable in radiologists’ diagnostic performance and confidence while IR exhibited higher subjective image quality than FBP.

     

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.     

急性阑尾炎16排螺旋CT低剂量腹部平扫并重建的CT征象及临床价值分析

目的:对急性阑尾炎16排螺旋CT低剂量腹部平扫并重建的CT征象及临床价值进行分析研究。材料与方法:随机抽取80例经手术病理证实的急性阑尾炎患者作为研究对象,所有患者均具有完整的CT检查资料,对其进行回顾性分析。结果:本组研究中CT诊断的符合率为95.0%;CT直接征象为管壁增厚,阑尾增粗,阑尾内结石,间接征象为阑尾周围脓肿,邻近回盲部肠壁增厚,阑尾浆膜面模糊及阑尾周围炎性改变。结论:16排螺旋CT低剂量腹部平扫及重建可清晰显示急性阑尾及其周围病灶,在临床诊断急性阑尾炎方面确诊率较高,其具有积极的应用价值。     

血吸虫性阑尾炎CT征象及其诊断价值

目的 探讨血吸虫性阑尾炎的CT征象及其诊断价值。方法 收集26例经手术病理证实的血吸虫性阑尾炎患者,并随机选取36例非血吸虫性阑尾炎患者,观察并比较其CT表现,包括阑尾形态、阑尾石形态和邻近结肠壁是否钙化。结果 血吸虫性阑尾炎与非血吸虫性阑尾炎患者间阑尾增粗、阑尾壁增厚和阑尾周围炎症差异均无统计学意义（P均>0.05）,但与非血吸虫阑尾炎相比,血吸虫性阑尾炎的结肠壁钙化和阑尾石呈双轨状更多见,差异有统计学意义（P均<0.05）。结论 CT平扫加MPR和CPR示阑尾石双轨状和阑尾周围肠壁钙化有助于诊断血吸虫性阑尾炎。     

Saline-filled appendiceal ultrasonography in clinically equivocalacute appendicitis

Background: To establish the value of saline-filled appendiceal ultrasonography in the the diagnosis of clinically equivocal acute appendicitis. Methods: Saline-filled ultrasonography was performed in 43 patients with an equivocal clinical diagnosis of acute appendicitis. Results: Sonography diagnosed 31 of 32 patients without acute appendicitis (97%). A normal appendix was visualized in 15 patients (47%), and we identified a normal appendix in 15 of 22 patients (68%) in whom the colon was cleansed with Golytely?. Sonography diagnosed 10 of 11 patients with acute appendicitis (91%). In three of 10 patients, the findings corresponded to sonographic pitfalls. Conclusion: Saline-filled appendiceal ultrasonography enables the detection of a normal appendix and may overcome sonographic pitfalls in acute appendicitis. Received: 2 June 1995/Accepted: 18 July 1995     

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。     

Can ruptured appendicitis be detected preoperatively in the ED?

PURPOSE: The purpose of this study is to determine which clinical symptoms/signs and computed tomography (CT) signs can help in distinguishing ruptured from simple appendicitis. MATERIALS AND METHODS: The medical records and CT findings of 202 consecutive patients with surgically proven acute appendicitis were retrospectively reviewed and compared between 2 groups with and without appendiceal rupture. RESULTS: Longer duration of symptoms ( P < .001), peritoneal sign ( P = .004), and higher C-reactive protein ( P < .001) are significant clinical factors for predicting appendiceal rupture in acute appendicitis. Abscess, extraluminal air, wall defect, peritoneal enhancement, extraluminal appendolith, phlegmon, localized fluid, fascial thickening, ascites, stool impaction, and 4 patterns of bowel wall thickening ( P < .001 to P = .047) are significant CT signs for predicting appendiceal rupture. The appendiceal diameter is larger in patients with ruptured appendicitis than in those with simple appendicitis (13.2 +/- 3.2 vs 11.3 +/- 2.4 mm, P < .001). The appendolith size is larger in patients with ruptured appendicitis than in those with simple appendicitis (7.1 +/- 4.4 vs 5.1 +/- 2.8 mm, P = .018). CONCLUSION: Besides some clinical findings, CT scan can accurately determine appendiceal rupture in acute appendicitis and can further demonstrate the presence of local inflammatory mass, facilitating management decision in the emergency department (ED).