高频超声诊断急性阑尾炎的临床价值

目的：探讨高频超声探头检查在急性阑尾炎诊断中的临床价值。方法：对。130例临床疑诊急性阑尾炎患者的超声检查结果进行临床随访、分析，其中116例经手术及病理证实。结果：高频超声诊断急性单纯性阑尾炎符合率93．5％；急性化脓性阑尾炎诊断符合率95．3％；急性坏疽性阑尾炎诊断符合率90．9％；阑尾周围脓肿诊断符合率100％；阑尾粪石诊断符合率100％；阑尾穿孔诊断率41．2％；总假阴性率为3．1％；总误诊率为1．5％。结论：高频超声对急性阑尾炎检查简单、快速、无损伤、费用低，而且准确率高，有较大的临床价值，可作为急性阑尾炎影像学检查的首选方法。     

彩色多普勒超声在急性阑尾炎诊断中的应用

目的：探讨高频和低频超声联合应用对急性阑尾炎的诊断价值。方法：对我院疑诊为急性阑尾炎的137例腹痛患者进行常规腹部超声检查,联合应用高频（7.5～10.0MHz）探头和低频（3.5MHz）探头,并与手术病理结果进行对照分析。结果：137例中超声显示阑尾区异常回声110例（显示率80.3%）。病理诊断为急性单纯性阑尾炎79例,超声诊断56例（符合率70.9%）;病理诊断为急性化脓性阑尾炎43例,超声诊断39例（符合率90.7%）;坏疽性及穿孔性阑尾炎13例、阑尾周围脓肿2例,超声与病理诊断结果一致。结论：彩色多普勒超声高频和低频探头的联合应用,对提高急性阑尾炎的诊断及其分型有较高的临床价值。     

彩色多普勒超声诊断急性阑尾炎的临床价值探讨

目的探讨彩色多普勒超声诊断急性阑尾炎的价值。方法对135例临床诊断为阑尾炎的病例应用腹部探头和高频探头,对阑尾细微结构进行观察分析。结果135例手术病理及治疗后复查:急性单纯性阑尾炎65例,超声检出58例,占89.2%;化脓性阑尾炎32例,超声检出30例,占93.8%;坏疽性阑尾炎14例,超声检出10例,占71.4%;阑尾穿孔5例,超声检出4例,占80%;阑尾周围脓肿9例,超声检出7例,占88.9%。结论结合应用腹部探头和高频探头,可以提高阑尾的显示率,并利于对各型阑尾炎进行分类,从而可帮助临床选择恰当的治疗方法和手术方案。     

高频超声在新生儿阑尾炎中的诊断价值

目的探讨高频超声在新生儿阑尾炎中的诊断价值。方法对44例怀疑新生儿阑尾炎的患儿和50例无腹部症状的正常新生儿进行高频超声检查,并与手术病理对照。结果 44例中,手术治疗33例,保守治疗11例。经手术治疗33例中,急性单纯性阑尾炎3例;急性化脓性阑尾炎5例;急性坏疽性阑尾炎7例;急性穿孔性阑尾炎14例;新生儿坏死性小肠结肠炎(NEC)、阑尾扩张充血4例,正确诊断29例,确诊率88%。其中4例合并其他疾病,一例急性化脓性阑尾炎合并有睾丸脓肿,1例急性坏疽性阑尾炎合并美克尔憩室,1例急性坏疽性阑尾炎合并有慢性新生儿坏死性小肠结肠炎,1例急性穿孔性阑尾炎合并新生儿坏死性小肠结肠炎。50例正常新生儿中有34例阑尾显影,阑尾显示率68%。结论本研究证明,高频超声不仅可以显著提高新生儿阑尾炎的诊断符合率,还可以为新生儿阑尾炎的鉴别诊断提供诊断依据。     

高频超声诊断急性阑尾炎的方法学探讨

 目的 为提高高频超声诊断急性阑尾炎的准确性,对超声检查方法进行探讨.方法 对440例临床疑似急性阑尾炎患者分别用方法一和方法二进行检查,并与手术及病理结果对照分析.结果 方法一和方法二对各型急性阑尾炎的诊断符合率分别为:单纯性阑尾炎为84.44%(114/135)vs 95.56%(129/135)(P<0.05);化脓性阑尾炎为89.84%(115/128)vs 92.97%(119/128)(P>0.05);坏疽及穿孔性阑尾炎为87.16%(95/109)vs 90.83%(99/109)(P>0.05);阑尾周围脓肿为85.71% (48/56)vs 100%(56/56)(P<0.05).结论 方法二可明显提高高频超声对急性单纯性阑尾炎和阑尾周围脓肿术前诊断的准确性.     

彩色多普勒超声在急性阑尾炎中的应用价值（附110例分析）

目的：分析急性阑尾炎（包括不同病理类型）的彩色多普勒超声声像图并评价其诊断价值。方法对110例手术病理证实的急性阑尾炎患者进行超声声像图的分析。结果110例急性阑尾炎中,超声确诊100例,漏诊10例,总符合率91.1％,其中急性单纯性阑尾炎符合率88.7％（55／62）,化脓性阑尾炎符合率93.7％（30／32）,坏疽性阑尾炎符合率92.6％（11／12）,阑尾周围脓肿符合率100％（4例）。结论彩色多普勒超声能根据超声声像图特征进行急性阑尾炎的诊断及分型,对诊断急性阑尾炎有较高的准确性,可为临床诊断和治疗阑尾炎提供可靠的依据。     

彩色多普勒超声诊断急性阑尾炎124例分析

目的:分析急性阑尾炎的超声声像图特征及漏诊原因,以进一步提高急性阑尾炎的超声诊断水平。方法:总结分析2009-02～2012-04的124例经手术及病理证实为急性阑尾炎的超声检查结果,着重讨论各型阑尾炎的超声特征及漏诊原因。结果:124例急性阑尾炎的患者,均经手术及病理证实。急性化脓性阑尾炎62例,急性坏疽性阑尾炎并穿孔30例,急性单纯性阑尾炎26例,阑尾周围脓肿4例,误诊2例。超声诊断符合率83.1%。结论:了解急性阑尾炎的声像图特征及漏诊原因,全面仔细的超声检查,对提高急性阑尾炎的超声诊断率有重要意义。     

急性阑尾炎超声诊断的图像特征及临床价值

目的探讨超声在诊断急性阑尾炎中的图像特征及诊断价值。方法回顾性分析经临床手术证实的78例急性阑尾炎患者的超声资料。结果病理诊断单纯性阑尾炎23例，化脓性阑尾炎39例，坏疽性阑尾炎10例，阑尾周围脓肿6例。结论急性阑尾炎具有较典型的超声声像图特征，可为临床提供客观的诊断依据。     

B超在急性阑尾炎检查诊断中的应用价值

目的：总结近年来我院超声诊断疑似急性阑尾炎的体会,旨在进步提高疑似急性阑尾炎的诊断水平。方法：对所有疑似的急性阑尾炎术常规B超检查,与手术诊断比较,分析超声诊断的价值。结果：在36例急性阑尾炎患者中,急性单纯性阑尾炎10例,急性化脓性阑尾炎18例,急性坏疽性阑尾炎5例,阑尾周围脓肿3例。结论：对于无法确诊的疑似急性阑尾炎患者,应用超声检查可显著提高诊断正确率。     

螺旋CT扫描诊断急性阑尾炎的应用价值

目的：探讨螺旋CT扫描诊断急性阑尾炎的应用价值。方法：分析我院拟诊急性阑尾炎26例螺旋CT资料。结果：均经手术证实，单纯性阑尾炎6例，急性化脓性阑尾炎12例，阑尾穿孔伴局部腹膜炎4例，阑尾脓肿2例，伴发弥漫性腹膜炎1例，局部出现肿块1例。阑尾形态正常1例，周围无炎症表现；右侧输尿管结石1例。CT扫描，急性阑尾炎多有阑尾增粗、壁增厚、阑尾腔积气、阑尾粪石、阑尾壁强化缺损等；同时可有阑尾周围炎性病变、积液及反射性肠淤胀等。结论：螺旋CT有助于急性阑尾炎的诊断及鉴别诊断。     

不同频率超声探头在高原地区急性阑尾炎诊断中的应用

目的：探讨低频、高频、阴道探头相结合的方法在高原地区急性阑尾炎诊断中的价值。方法：回顾性分析2010-05-2012-05间临床怀疑阑尾炎的113例患者的超声检查结果,并与手术结果进行对照分析;每位患者术前分别用3种探头经腹检查1次,可经阴道检查的女性再行经阴道检查。结果：113例中,超声提示阑尾炎的98例中手术证实96例,仅高频探头诊断45例（46.9%）,低频探头诊断12例（12.5%）,阴道探头诊断（包括经腹和经阴道扫查）16例（16.7%）,其中经腹诊断11例,经阴道扫查的45例共诊断5例;23例为2种或3种方法同时诊断。误诊2例,1例为小儿肠系膜淋巴结炎,1例为盆腔炎;超声检查呈阴性的15例中,手术证实5例为阑尾炎。本研究的超声诊断敏感性为95.0%,特异性83.3%,准确性93.8%,阳性预测率98.0%,阴性预测率66.7%。结论：阴道探头与低频探头、高频探头相结合的方法对急性阑尾炎具有较高的诊断价值,超声检查已成为高原地区诊断急性阑尾炎不可缺少的影像检查方法。     

Enhanced CT in the diagnosis of acute appendicitis to evaluate the severity of disease: comparison of CT findings and histological diagnosis

PURPOSE: To assess the potential of CT in evaluating the histological severity of acute appendicitis in comparison with surgical and pathological findings. METHOD: The CT images of 75 patients with surgically proven appendicitis, including 10 cases of catarrhal, 34 of phlegmonous, and 31 of gangrenous appendicitis, were retrospectively analyzed for the following five CT findings: (1) hazy periappendiceal densities, (2) enlarged appendix, (3) increased enhancement of the appendiceal wall, (4) increased enhancement of the periappendiceal intestinal wall, and (5) deficiency of the appendiceal wall. By comparing all the CT findings and the pathological severity of appendicitis (catarrhal, phlegmonous, and gangrenous), the prevalence of the five CT findings was calculated for each pathological category. RESULTS: Abnormal CT findings were noted in only one case of catarrhal appendicitis. Increased enhancement of the appendiceal wall was observed in all 29 cases of phlegmonous appendicitis (100%), but in only 66.7% (18 cases) of gangrenous appendicitis. Deficiency of the appendiceal wall was more frequently observed in gangrenous (19/27, 70.4%) than phlegmonous appendicitis (4/29, 13.8%). CONCLUSION: Findings of enhanced CT provide useful information in evaluating the pathological severity of acute appendicitis.     

Diagnostic role of echography in acute appendicitis in children]

Eighty-seven pediatric patients with suspected acute appendicitis underwent high-resolution US with graded abdominal compression. The study was limited to the patients with a questionable clinical diagnosis, accounting for about 40% of the patients examined for acute appendicitis in our Institution. US had 87.3% accuracy, 81.5% sensitivity, and 90% specificity. The main US findings in the positive cases were: visualization of the appendix as a tubular non-compressible structure, with a diameter of 5 mm or more, symmetric/asymmetric wall thickening, possible presence of appendicoliths and variable appearance of the central echogenic layer (preserved, doubled for lumen dilatation, partially/totally lost). The above US findings were grouped in 3 basic patterns: type I (thickened appendix with no structural abnormalities) appeared to be related to non-suppurative and phlegmonous acute appendicitis; type II (detectable appendiceal abnormalities) was observed both in phlegmonous and in suppurative acute appendicitis; type III (pericecal complex mass, frequently with appendicoliths) was found in all cases of periappendiceal abscess. In our experience, the use of US in the diagnosis of acute appendicitis in children allowed a reduction by about 2/3 in the rate of unnecessary laparotomies. Such a finding emerges from the comparison with the results obtained in the 2 years prior to the use of US. The technique also allowed an unquestionable diagnosis of acute appendicitis or periappendiceal abscess to be made in a number of clinically equivocal cases, thus avoiding potentially harmful delays in diagnosis. On the other hand, the incidence of false-negatives on US is not negligible, which calls for a cautious clinical and US evaluation of all equivocal cases following no typical US pattern.     

急性阑尾炎MRI诊断的临床意义

目的 探讨急性阑尾炎的MRI表现及其临床意义.资料与方法 采用MRI SsH/T_2W-DRIVE序列、SsH/T_2WI序列、STIR/TSE序列和B-SPIR-TFE序列对20例临床诊断为急性阑尾炎和21例右下腹疼痛原因待查的患者进行MRI,采用统计学方法比较两组间差异,并与随后的手术结果进行对照.结果 急性阑尾炎在临床明确诊断组中,阑尾腔外径平均为(0.605±0.205)cm、平均壁厚(0.318±0.106)cm;在腹痛原因待查组中,阑尾腔外径平均为(0.613±0.185)cm、阑尾平均壁厚(0.354±0.179)cm,两者间差异无统计学意义.与手术结果对比,急性单纯性阑尾炎主要表现为阑尾壁T_2信号增高和无阑尾周局部积液;化脓性阑尾炎主要表现为阑尾腔扩张、阑尾腔T_2信号增高、阑尾壁增厚、阑尾壁T_2信号增高或有阑尾周围局部积液;而坏疽性阑尾炎表现与化脓性阑尾炎相似;阑尾脓肿则表现为阑尾消失和回盲部包裹性高信号.MR图像能清晰地显示阑尾的具体位置.结论 采用MRI不同序列检查,能在定位与分期诊断上为临床选择治疗方案和采取预防并发症的措施提供重要依据.     

应用多层螺旋CT多方位重建技术诊断急性阑尾炎的价值

目的探讨多层螺旋CT多方位重建(MPVR)诊断急性阑尾炎的价值。方法2002年2月至2003年9月临床疑诊阑尾炎收治入院手术患者39例,术前均作了常规扫描和MPVR重建2种CT检查,术后31例确诊为阑尾炎,从阑尾充血、水肿至阑尾脓肿共分5级(正常阑尾为0级)。结果对照手术病理,MPVR重建诊断急性阑尾炎准确率872%,敏感度903%,特异度75%,阳性预测值933%,阴性预测值667%。常规CT检查诊断急性阑尾炎准确度385%,敏感度387%,特异度375%,阳性预测值706%,阴性预测值136%。28例确诊急性阑尾炎的MPVR重建片所示5种主要征象及出现频率如下阑尾肿大(管腔直径>6mm)(964%),阑尾结石(267%),回盲部肥厚(367%),阑尾周围炎(714%),脓肿(107%)。结论多层螺旋CTMPVR重建技术显著提高了CT对临床症状模棱两可、临床疑诊急性阑尾炎患者的术前诊断能力,并可减少重型阑尾炎病例的发生。     

CT of appendicitis

The CT findings of 38 consecutive patients with acute appendicitis are analyzed, described, and illustrated. CT showed intraabdominal disease in 92% of patients and made a specific diagnosis of appendicitis in 79% of cases. The most common CT findings were pericecal inflammation (68%), abscess (55%), calcified appendicolith (23%), and an abnormal appendix (18%). CT had a sensitivity similar to that of contrast enema examinations, but it correlated much better with the surgical findings in detecting the precise nature, extent, and location of the disease process. Normal CT does not exclude appendicitis, since mild forms without periappendiceal disease may escape detection.     

Beyond acute appendicitis: imaging and pathologic spectrum of appendiceal pathology

While acute appendicitis is a common and important clinical problem, a variety of other disease processes can affect the appendix. Simple and perforated appendicitis, tip appendicitis, and stump appendicitis share a common clinical presentation including anorexia, right lower quadrant pain, and fever. By imaging, most cases of acute appendicitis exhibit luminal dilation, wall thickening, and periappendiceal inflammatory stranding. In tip appendicitis, these changes are isolated to the distal appendix, often with an obstructing appendicolith. Perforated appendicitis can exhibit mural discontinuity, periappendiceal abscess, and/or extraluminal appendicoliths. After appendectomy, the appendiceal remnant or “stump” can become inflamed, often necessitating repeat surgery. Inflammatory bowel disease can involve the terminal ileum, secondarily involving the appendix, or may primarily involve the appendix. Patient symptoms can be chronic in such cases, and mucosal hyperenhancement is a pronounced imaging feature. In asymptomatic patients without appendiceal inflammation, the appendix can be dilated by intraluminal material such as inspissated succus in cystic fibrosis or mucus from benign appendiceal mucocele. Finally, neoplasms such as typical appendiceal carcinoid tumor and mucinous adenocarcinoma can involve the appendix. Carcinoids are often small and incidentally discovered at pathologic examination, while malignant mucinous adenocarcinoma tends to present with advanced disease including pseudomyxoma peritonei. Cecal cancers can also obstruct the appendiceal lumen and cause acute appendicitis; an astute radiologist can recognize this prospectively and facilitate definitive resection (right hemicolectomy) at the time of surgery. Attention to mural features, cecal configuration, and periappendiceal inflammation is essential to the correct prospective diagnosis of complicated appendicitis and less common appendiceal pathologies.     

高低频超声结合在诊断急性阑尾炎中的临床价值

目的:探讨高频超声和低频超声联合应用在诊断急性阑尾炎中的临床价值。方法:对2008年5月～2010年5月我院临床怀疑急性阑尾炎者先行低频超声扫查,然后联合应用高频超声对比扫查。对123例术后病理证实为急性阑尾炎的超声图像进行回顾性分析。结果:低频超声诊出阑尾炎88例,符合率71.5%,低频超声联合高频超声诊出阑尾炎109例,符合率88.6%。阑尾长轴切面呈腊肠样盲端结构,短轴切面呈"同心圆"征。结论:高、低频超声联合应用能有效提高急性阑尾炎的超声诊断符合率,为临床治疗方案的判定提供重要的参考依据,在诊断急性阑尾炎中有重要的临床意义。     

Acute Appendicitis or Lymphoid Hyperplasia: How to Distinguish More Safely?

PurposeLymphoid hyperplasia can be an important mimicker of acute appendicitis by creating a non-compressible appendix more than 6 mm in diameter. The aim of this study was to evaluate methods of distinguishing lymphoid hyperplasia and appendicitis on the basis of sonography, lamina propria thickness, and Alvarado scoring.MethodsThis retrospective study included 259 patients (142 appendicitis, 117 lymphoid hyperplasia). The US (ultrasound) reports of the patients were reviewed and the maximum diameter of the appendix, the presence or absence of increased echogenicity of the surrounding pericaecal fat, local fluid collection, the presence of reactive lymph nodes in the periappendiceal area, and mural hyperemia within the appendix were recorded.ResultsThe use of additional sonographic criteria, lamina propria thickness (≤1 mm is indicative for appendicitis), or Alvarado scoring (>6 mm is indicative for appendicitis) provided a true-positive diagnosis for acute appendicitis.ConclusionThe presence of local fluid collection in the periappendiceal area and a lamina propria thickness ≤ 1 mm are the most successful parameters for distinguishing appendicitis from lymphoid hyperplasia.