64层螺旋CT平扫诊断成人急性阑尾炎的价值研究

目的探讨64层螺旋CT平扫诊断急性阑尾炎的临床价值。方法采用美国GE Light Speed 64层螺旋CT扫描机,行连续容积扫描,对98例临床怀疑急性阑尾炎的患者行64层螺旋CT平扫扫描,采用多平面重建法(MPR)、曲面重建法(CPR)、最大密度投影(MIP)技术重建,总结分析急性阑尾炎CT平扫表现,通过与手术病理比较评估CT平扫对诊断急性阑尾炎的敏感度、特异度、阳性预测值、阴性预测值和准确性,并探讨其临床价值。结果 98例疑似急性阑尾炎患者54例行手术治疗,47例经手术病理证实为急性阑尾炎,其中平扫诊断46例,3例为假阳性,2例为盲肠憩室炎,1例为回肠末端炎,4例未能诊断。平扫诊断急性阑尾炎的敏感度为91.5%、特异度为94.1%,阳性预测值为93.5%,阴性预测值为92.3%,准确度为92.9%。同手术病理相比无统计学差异。病理诊断正常阑尾7例(因临床怀疑而行手术治疗)。7例正常阑尾中,盲肠憩室炎2例,回肠末端炎1例,盲肠炎1例,盆腔炎1例,无异常发现2例。结论 CT平扫可以快速准确地显示急性阑尾炎及其并发症,而且操作简便无造影剂过敏之忧,病人承担费用少,辐射剂量低,特别适用一些急重的急腹症的患者,可以作做为怀疑急性阑尾炎而临床表现不典型的患者的首选检查方法。

The Value of 64-slice Spiral CT Non-contrast Enhanced Scan in the Diagnosis of Adult Acute Appendicitis

Objective To discuss the value of 64-slice spiral CT plain scan in the diagnosis of acute appendicitis. Methods 98 patients who were clinical suspected of acute appendi- citis were scanned with 64-slice spiral CT using plain continuous volume scanning. The source images were reconstructed into three-dimensional images using the technique of multiplanar reconstruction（MPR）, curved planar reconstruction（CPR） and maximum in- tensity projection（M1P）. The CT images were retrospectively analyzed and were corn- paled with pathological results, and evaluated the sensibility, specificity, positive predic- tive value and negative predictive value of the CT plain scan. Results Of the 98 patients, 47 of 54 patients who underwent surgery had pathologically proved of acute appendicitis. 46 patients were diagnosed as acute appendicitis by plain scan and 3 of them had false negative findings. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of plain scan were 91.5%, 94.1%, 93.5%, 92.3%, 92.9%. There was no significant difference between plain scan and pathologically.（P〉0.05） Conclusion MSCT plain scan can quickly and accurately display acute appendic~：is and its complication, and has the advantages of simple operation without contrast medium allergic worries, patient costs less, accepts low radiation dose, especially for some emergency of acute abdomen patients. It can be used as the preferred inspection method for the patients who were suspected acute appendicitis with atypical clinical manifestations.