64排螺旋CT诊断急性阑尾炎的价值

目的探讨64排螺旋CT对急性阑尾炎的诊断价值。方法收集本院46例临床上拟诊急性阑尾炎的病例。术前均采用Philips Brilliance 64排螺旋CT进行常规扫描及多层面重组。其中12例患者行双期增强扫描,总结分析,并将CT表现与手术病理结果作比较。结果在46例急性阑尾炎患者中,有32例CT显示阑尾异常增粗、壁增厚,42例显示阑尾周围渗出性炎性改变(表现阑尾周围脂肪间隙斑片状及条索状模糊影),6例阑尾周围脓肿形成,另外,阑尾内结石15例,腹腔少量积液8例,30例筋膜局限性增厚,局限性盲肠壁增厚6例,腹膜炎及低位肠梗阻4例,腔外游离气体2例。结论 64排螺旋CT扫描对急性阑尾炎的诊断具有较高价值。     

CT对不典型阑尾炎的诊断价值

目的探讨CT对症状不典型急性阑尾炎的诊断价值。方法收集临床首诊未考虑阑尾炎,而经手术和病理证实的阑尾炎病例23例,对其CT表现进行观察分析。结果有11例表现为阑尾增粗,肠壁增厚;2例表现为右下腹脓肿;2例盲肠周围可见少量游离气体影;3例女性患者表现为盆腔脓肿;4例表现为盲肠及回肠肠壁增厚,周围渗液;1例伴有小肠梗阻。其中6例阑尾内可见结石。结论 CT能清楚显示阑尾的位置、形态以及周围组织的关系,对不典型阑尾炎的临床诊断,具有较高价值。     

多层螺旋CT诊断急性阑尾炎的临床价值分析

目的探讨多层螺旋CT在急性阑尾炎诊断中的应用价值。方法对本院收治的急性阑尾炎患者采用多层螺旋CT检查,并与手术病理检查结果进行对比研究。结果本组急性阑尾炎患者经CT检查后,阑尾炎位置以回肠前位最多,占30.40%;阑尾直径6mm 120例,占96.00%;阑尾积液75例,占60.00%;阑尾腔内粪石58例,占46.40%;阑尾腔外粪石4例,占3.20%;阑尾腔内积气18例,占14.40%;阑尾周围腹腔内游离气体7例,占5.60%;阑尾及周围肠壁增厚水肿100例,占80.00%;阑尾局部缺损9例,占7.20%;阑尾周围炎及邻近筋膜增厚88例,占70.40%;阑尾周围蜂窝织炎及脓肿19例,占15.20%;盆腔炎4例,占3.20%;腹水21例,占16.80%。结论多层螺旋CT能显示阑尾积液、阑尾腔内粪石、阑尾及周围肠壁增厚水肿、阑尾周围炎及邻近筋膜增厚等征象,对临床有很高的应用价值。     

64排螺旋CT对急性阑尾炎的诊断价值

目的探讨64排螺旋CT及重建功能在急性阑尾炎中的诊断价值。方法收集我院住院非阑尾炎患者51例,作为对照组,统计CT对正常阑尾显示率和测量阑尾外直径。收集同期住院手术并经病理诊断急性阑尾炎病例36例,作为实验组,统计患者阑尾外直径和CT诊断阑尾炎的准确率,两组病例测量数值进行统计学处理;观察、总结急性阑尾炎CT影像特征。结果 64排螺旋CT对正常阑尾显示率为98.0%,对急性阑尾炎诊断准确率为96.6%;正常阑尾外直径为(7.7±1.8)mm,急性阑尾炎患者阑尾外直径为(11.1±3.4)mm,两样本均数差别有高度显著性(T=3.67,P0.01);在急性阑尾炎时,阑尾外直径明显增粗,阑尾本身结构模糊,周围脂肪间隙密度增高,可形成渗出和包块;重建技术能够多方位显示阑尾,并能清晰显示阑尾与周围组织、器官的相关信息。结论 64排螺旋CT可快速准确显示急性阑尾炎及其并发症,对于一些危重的急腹症患者、尤其是怀疑急性阑尾炎患者应首选进行CT扫描。     

32层螺旋CT三维重组在急性阑尾炎诊断及鉴别诊断中的价值

目的：探讨32层螺旋CT三维重组诊断急性阑尾炎的临床应用。方法：搜集60例临床拟诊急性阑尾炎的病例,采用32层螺旋CT进行扫描,以1.25mm层厚行薄层多平面容积重组图像后处理,总结分析其CT表现,并将诊断结果与手术及病理结果进行对照。结果：60例患者中,诊断为急性阑尾炎54例,右侧腹股沟疝1例,右侧输尿管下段结石1例,胆囊炎1例,结肠肿瘤1例,假阴性2例。其中CT表现为阑尾水肿、增粗、管壁增厚者52例,阑尾腔内肠石10例,阑尾周围炎45例,回盲部壁增厚12例,阑尾脓肿2例,阑尾穿孔2例,其中1例并发腹膜炎及麻痹性小肠梗阻。结论：急性阑尾炎有典型的CT表现,32层螺旋CT三维重组及图像后处理技术能从不同角度显示阑尾及其周围情况,在急性阑尾炎的诊断和鉴别诊断中,有较高的临床应用价值。     

MSCT对老年人不典型阑尾炎的诊断价值

目的探讨多层螺旋CT(MSCT)对老年人不典型阑尾炎的诊断价值。方法搜集32例年龄>60岁,临床首诊非急性阑尾炎的病例,而经MSCT诊断为急性阑尾炎,并且均经手术及病理证实。回顾性分析其CT表现及特征。结果 32例急性阑尾炎患者中,单纯性阑尾炎5例,化脓性阑尾炎伴阑尾周围炎18例,坏疽伴穿孔性阑尾炎7例,阑尾脓肿2例,其中,阑尾腔内肠石19例,肠石位于阑尾腔外1例,并发腹膜炎3例,结肠肿瘤2例。结论老年人急性阑尾炎的临床症状和体征大多不典型,易误诊。MSCT平扫及图像后处理技术的联合应用,能直观地显示阑尾的形态及病理改变,在对老年人急性阑尾炎快速、准确的诊断中,有重要的临床应用价值。     

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。     

多层螺旋CT与超声对急性阑尾炎患者的临床诊断价值

目的比较分析多层螺旋CT与超声对急性阑尾炎患者的临床诊断价值。方法选取我院收治的63例急性阑尾炎患者作为研究对象,分别进行多层螺旋CT与超声检查,将检查结果与手术病理结果相比较,分析两者的临床诊断价值。结果与手术病理比较,多层螺旋CT对阑尾结构完整可辨、阑尾结构难辨、阑尾结构不清、团块等各型的诊断符合率分别为95.24%、80.00%、100.00%、100.00%。超声的诊断符合率分别为83.33%、66.67%、75.00%、100.00%。多层螺旋CT的总诊断符合率明显高于超声,多层螺旋CT与超声对急性单纯性阑尾炎的诊断符合率分别为100.00%、59.46%。急性化脓性阑尾炎的诊断符合率分别为75.00%、50.00%,急性坏疽性阑尾炎的诊断符合率均为100.00%。多层螺旋CT的诊断符合率明显高于超声,尤其是对急性单纯性阑尾炎的诊断符合率明显高于超声,差异具有统计学意义(P0.05)。结论多层螺旋CT应用于急性阑尾炎的诊断及分型,与临床病理诊断符合率高于超声。典型的CT征象为阑尾直径6mm、阑尾及周围肠壁增厚、存在积液等,为急性阑尾炎的诊断提供参考。     

多层螺旋CT对急性阑尾炎的诊断

目的 分析急性阑尾炎的多层螺旋CT(MSCT)诊断价值.方法 对58例经手术、临床证实的急性阑尾炎的阑尾大小、形态及盲肠周围改变等CT资料进行回顾性分析.结果 38例显示异常阑尾(肿大增粗、壁增厚、腔内结石积液等),46例显示阑尾周围炎性改变(阑尾周围脂肪内斑点状及条纹状模糊影、腹腔少量积液、右侧侧锥筋膜增厚、腰大肌前缘模糊、右侧肾周筋膜增厚),腔外气体2例,腔外结石1例,局限性盲肠壁增厚12例.结论 MSCT在急性阑尾炎的诊断中有重要的价值.     

MSCT对不典型临床表现急性阑尾炎的诊断价值

目的:探讨多层螺旋CT(MSCT)对不典型临床表现急性阑尾炎的诊断价值。方法:收集临床首诊未诊断为阑尾炎而来我科做CT检查的患者24例,经手术和病理证实为阑尾炎,回顾分析CT表现。结果:CT表现有:11例表现为阑尾增粗,壁增厚;②阑尾周围炎18例;③右下腹局限性脓肿4例;④其中9例阑尾内见结石;⑤2例为假阴性。结论:临床症状和体征不典型的阑尾炎绝大部分病例根据CT平扫表现可获得正确诊断。     

The prevalence and patterns of intraluminal air in acute appendicitis at CT

The purpose of this study is to investigate if the presence and distribution of intraluminal air in the appendix contributes to the computed tomography (CT) diagnosis of appendicitis. We identified 100 consecutive patients (57 men and 43 women; mean age, 38) with CT prior to appendectomy for acute appendicitis over a 5-year period and a control group of 100 consecutive patients (29 men and 71 women; mean age, 39) who underwent CT for acute abdominal pain without appendicitis. Patients were scanned using multidetector row CT scanners at 1.25 or 5-mm slice thickness, peak tube voltage of 120 kVp, and milliamperse automatically adjusted to attain a noise index of 12. Ninety-two of 100 study patients and 95 of 100 controls received 150 mL intravenous contrast. Two independent readers noted the presence and distribution pattern of intraluminal air in the appendix, appendiceal diameter, wall hyperemia, wall thickening (>3 mm), and wall stratification and presence of any secondary signs of appendicitis including fat stranding and free fluid. Data were compared between groups using Fisher’s exact test and Student’s t test. Intraluminal air in the appendix was more common in control patients versus patients with appendicitis (66 of 100 versus 27 of 100, p?<?0.001). No significant differences in the patterns of intraluminal air were found between cases and controls. Among appendicitis cases, there was no significant difference in mean appendiceal diameter (12.8 versus 12.0, p?=?0.20) or number of CT signs of appendicitis (1.93 versus 1.86, p?=?0.78) in cases with intraluminal air versus without. No case of appendicitis demonstrated intraluminal air without secondary signs of appendicitis. Although intraluminal air is sometimes assumed to exclude a diagnosis of appendicitis, it is actually a common finding seen in up to 27 % of cases at CT. The pattern of intraluminal air was not helpful in differentiating a normal appendix from appendicitis.     

16层螺旋CT在急性阑尾炎诊断中的应用价值

目的探讨MSCT对急性阑尾炎的诊断价值。方法对99例手术病理证实为急性阑尾炎的MSCT检查资料进行回顾性分析,结合多平面重建技术(MPR)/曲面重建技术(CPR)分析急性阑尾炎的CT表现,并与临床病理对照。结果阑尾增粗82例,阑尾壁增厚38例,阑尾粪石43例,阑尾周围脂肪间隙"条纹征"80例,阑尾周围脓肿12例,阑尾穿孔18例,盲肠壁增厚与阑尾开口形成"箭头征"16例,右侧腰大肌肿胀模糊不清15例,腹腔积液20例,合并肠梗阻8例,阑尾无明显异常3例,CT诊断正确96例,诊断符合率为97%。结论 MSCT薄层扫描结合MPR/CPR技术在急性阑尾炎诊断中具有很高的应用价值,同时可以提高鉴别诊断能力,可作为急性阑尾炎的首选影像检查方法。     

Acute appendicitis: comparison of low-dose and standard-dose unenhanced multi-detector row CT

PURPOSE: To prospectively compare low- and standard-dose unenhanced multi-detector row computed tomography (CT) in patients suspected of having acute appendicitis. MATERIALS AND METHODS: Ninety-five consecutive patients underwent two unenhanced multi-detector row CT examinations with 4 x 2.5-mm collimation, 120 kVp, and 30 and 100 effective mAs. Two radiologists independently read the images obtained at each dose during two sessions. Readers recorded visualization of the appendix and presence of gas in its lumen, appendicolith, periappendiceal fat stranding, cecal wall thickening, and abscess or phlegmon to measure the diameter of the appendix and to propose diagnosis (appendicitis or alternative). Data were compared according to dose and reader, with definite diagnosis established on basis of surgical findings (n = 37) or clinical follow-up. chi(2) tests and logistic regression were used. Measurement agreements were assessed with Cohen kappa statistics. RESULTS: Twenty-nine patients had a definite diagnosis of appendicitis. No difference was observed between the frequency of visualization of the appendix (P =.874) neither in its mean diameter (P =.101-.696, according to readers and sessions) nor in the readers' overall diagnosis (P =.788) at each dose. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each sign were not different between doses. Fat stranding, appendicolith, and diameter were the most predictive signs, regardless of dose, yielding approximately 90% of correct diagnoses. The ability to propose a correct alternative diagnosis was not influenced by the dose. CONCLUSION: Low-dose unenhanced multi-detector row CT has similar diagnostic performance as standard-dose unenhanced multi-detector row CT for the diagnosis of acute appendicitis.     

What is the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after CT?

The objective of our study was to estimate the complementary role of ultrasound evaluation in the diagnosis of acute appendicitis after abdominoplevic CT. A total of 104 patients initially underwent abdominopelvic CT before appendix US due to acute abdominal pain. All CT examinations were evaluated retrospectively for the presence of acute appendicitis. The findings of appendix on CT were classified into five categories (definite appendicitis, probably appendicitis, equivocal CT findings for diagnosis of appendicitis, probably not appendicitis, and normal looking appendix). Appendix US images and their radiologic reports were also evaluated retrospectively. Then, CT and US findings were correlated with clinical or pathologic diagnosis. Three all patients with definite appendicitis initially on CT again showed US findings of appendicitis. In the 32 patients of probably appendicitis on CT, US showed normal looking appendix in seven patients (21.8%, 7 of 32) who improved with medical treatment and discharged. In the 16 patients of equivocal CT findings for diagnosis of appendicitis, US showed appendicitis in seven patients (43.8%, 7 of 16) and normal looking appendix in nine patients. In the 12 patients of probably not appendicitis on CT, US showed acute appendicitis in two patients (16.7%, 2 of 12). In the 41 patients of normal looking appendix on CT, US showed acute appendicitis in five patients (12.2%, 5 of 41). US reevaluation enables us to avoid misdiagnosis of appendicitis on CT and improve diagnostic accuracy of acute appendicitis.     

螺旋CT对急性阑尾炎的诊断价值

目的：探讨螺旋CT对急性阑尾炎的诊断价值。方法：搜集CT提示或诊断为阑尾炎并经手术病理证实的34例患者，回顾性分析其CT征象。结果：15例CT表现为阑尾增粗，壁增厚；26例表现为右下腹或盆腔炎性改变（如周围脂肪密度增高、肠周积液、蜂窝织炎、脓肿、腔外气体、淋巴结肿大、相邻肠管增厚、阑尾结石或粪石）；6例盲肠末端有局限性增厚；4例右侧腰大肌影模糊。结论：CT诊断急性阑尾炎有独到之处，能为临床合理治疗提供帮助。     

Right lower quadrant pain: value of the nonvisualized appendix in patients at multidetector CT

PURPOSE: To retrospectively determine the value of the nonvisualized appendix at multidetector computed tomography (CT) in patients with acute right lower quadrant pain in whom appendicitis was a consideration. MATERIALS AND METHODS: Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent. Records were retrospectively reviewed in patients who presented to the emergency department between April 29 and October 31, 2003, with right lower quadrant pain. Scanning was performed with the same eight-detector row CT scanner by using oral and (unless contraindicated) intravenous contrast agents, and transverse and coronal reformations were obtained. Two radiologists prospectively evaluated all scans at the time of the examination and rendered a consensus opinion. Clinical follow-up of at least 3 months' duration was performed retrospectively for patients whose appendix was not visualized to determine whether appendicitis had developed. Statistical analysis and calculation of percentages with confidence intervals (CIs) were performed. RESULTS: Of the 400 consecutive patients who underwent multidetector CT, 132 (33.0%) were male and 268 (67.0%) were female. Eighty patients (20.0%) had acute appendicitis and 79 (19.8%) had another cause for abdominal pain. A normal appendix with no other cause for pain was seen in 182 patients (45.5%). In 59 patients (14.8%), the appendix was not visualized. Of these 59 patients, 50 had adequate follow-up. Clinical follow-up was uneventful in 49 of these 50 patients. Thus, on otherwise normal multidetector CT scans in patients suspected of having acute appendicitis, nonvisualization of the appendix was negative for appendicitis in 98% (95% CI: 71%, 100%) of cases. Conversely, when the appendix was seen at multidetector CT and was abnormal, appendicitis was present in 95% (95% CI: 72%, 100%) of cases. CONCLUSION: In patients with right lower quadrant pain, a nonvisualized appendix at multidetector CT reliably excludes acute appendicitis.     

小儿急性阑尾炎CT诊断

目的　提高小儿急性阑尾炎CT诊断水平。方法　回顾性分析 35例经临床病理证实的 9岁以下急性阑尾炎的CT表现。结果　35例中阑尾肿大增粗,直径>6mm25例,阑尾腔内结石钙化 5例,盲肠周围炎并盲肠壁增厚 27例,肠淤张 22例。结论　CT对急性阑尾炎的诊断有较高的准确性和临床实用性。     

The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT

PURPOSE: To evaluate the most useful findings to look for in diagnosing acute appendicitis on contrast-enhanced helical CT. MATERIAL AND METHODS: Appendiceal helical CT scans with intravenous contrast administration (abdomen, 7-mm collimation; abdominopelvic junction, 5-mm collimation) of 71 patients with surgically proven acute appendicitis and 167 patients with alternative diagnoses were reviewed retrospectively. Three radiologists analyzed the following parameters: enlarged appendix (>6 mm in diameter), appendiceal wall thickening, appendiceal wall enhancement, no identification of the appendix, appendicolith(s), appendiceal intraluminal air, intramural air, extraluminal air, periappendiceal fat stranding, extraluminal fluid, phlegmon, abscess, lymphadenopathy, segmental terminal ileal wall thickening, focal cecal apical thickening, focal colonic wall thickening, and segmental colonic wall thickening. The features that best distinguished appendicitis from alternative diagnoses were selected with stepwise logistic regression analysis. RESULTS: Nine CT findings distinguished acute appendicitis from alternative diagnoses (P < 0.05): enlarged appendix (R = 0.739), appendiceal wall thickening (R = 0.525), periappendiceal fat stranding (R = 0.414), appendiceal wall enhancement (R = 0.404), focal cecal apical thickening (R = 0.171), appendicolith(s) (R = 0.157), extraluminal air (R = 0.050), intramural air (R = 0.043), and phlegmon (R = 0.030). Enlarged appendix (sensitivity, 93%; specificity, 92%), appendiceal wall thickening (sensitivity, 66%; specificity, 96%), periappendiceal fat stranding (sensitivity, 87%; specificity, 74%), and appendiceal wall enhancement (sensitivity, 75%; specificity, 85%) showed the statistically most significant association with acute appendicitis. CONCLUSION: On 5-mm-section contrast-enhanced helical CT examinations, enlarged appendix, appendiceal wall thickening, periappendiceal fat stranding, and appendiceal wall enhancement were the most useful findings for diagnosing acute appendicitis.