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。     

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。     

穿孔性阑尾炎与非穿孔性阑尾炎的CT鉴别诊断

目的:评价多排螺旋CT对穿孔性与非穿孔性阑尾炎的鉴别诊断价值.方法:搜集手术及病理证实的急性阑尾炎151例,并按照手术及病理结果分为穿孔组(66例)和非穿孔组(85例),总结分析其CT表现,并比较穿孔性与非穿孔性阑尾炎的CT表现.结果:阑尾腔外粪石、阑尾腔外气体、阑尾周围脓肿、阑尾壁局限性强化缺损对诊断阑尾炎穿孔有很高的特异性(P＜0.05),为诊断阑尾炎穿孔的特异性征象;阑尾周围炎、盆腔炎改变在穿孔组发现频率也明显高于非穿孔组(P＜0.05),穿孔组阑尾直径明显大于非穿孔组(P＜0.05),对诊断阑尾炎穿孔有一定价值;阑尾位置、阑尾腔内粪石、阑尾腔内气体、阑尾周围淋巴结肿大在两组中无明显差异(P＞0.05).结论:CT是诊断穿孔性阑尾炎有效、快速的方法,其中阑尾腔外粪石、阑尾腔外气体、阑尾壁局限性强化缺损、阑尾周围脓肿为诊断穿孔性阑尾炎较为特异的CT征象,阑尾周围炎、盆腔炎改变、阑尾直径增大对于诊断阑尾炎穿孔有一定价值.     

高频及低频彩超在急性阑尾炎诊断中的价值

目的：探讨高频及低频彩超对急性阑尾炎的诊断价值和准确性。方法：分析总结了25例急性阑尾炎病例,超声显像检查阑尾的大小、形态、壁的厚度,阑尾腔有无积液,有无扩张、有无粪石,周围有无积液等。结果：高频及低频彩超对急性阑尾炎的诊断符合率以低频最低,约35．9％,高频显示率明显提高,而二者结合效果最好,准确率约达到88．4％。结论：高频及低频彩超对急性阑尾炎的诊断及鉴别诊断有很大的价值。     

儿童急性阑尾炎的CT表现及其评价

目的：探讨儿童急性阑尾炎的CT表现及其诊断价值。方法：回顾性分析本院2007年1月～2008年12月经手术和病理证实的55例小儿急性阑尾炎的临床和CT资料,总结其CT表现特点和临床应用价值。结果：55例急性阑尾炎中,卡他型12例,化脓型25例,坏疽型18例。CT表现为阑尾肿胀增粗（37/55）;阑尾腔内肠石（35/55）;阑尾腔内积气（17/55）;阑尾穿孔并周围脓肿形成（18/55）;阑尾周围组织密度不均匀升高（19/55）;相邻盲肠壁增厚（24/55）;腹水（11/55）;肠梗阻（5/55）;其它还有肝脓肿、NEC等并发症形成。结论：儿童急性阑尾炎的CT表现具有一定特点,CT检查可显示阑尾及其周围组织结构的病理改变,为临床明确诊断提供客观依据,尤其适用于儿童。     

MDCT特征性征象诊断慢性阑尾炎的价值

目的探讨MDCT诊断慢性阑尾炎的价值。方法回顾分析经手术和临床随访证实的28例慢性阑尾炎患者的MDCT影像表现,探讨慢性阑尾炎的MDCT表现与病理改变的关系。结果慢性阑尾炎的病理改变:阑尾呈屈曲状;阑尾及其系膜与周围组织粘连;阑尾粗细不均匀,部分管腔完全闭塞;阑尾腔内常见粪石;阑尾浆膜充血。MDCT特征性征象:卷曲征71.4%,粘连征35.7%,塌陷征71.4%,阑尾石征46.4%,壁明显强化征39.3%。结论慢性阑尾炎病理改变有特征性,MDCT征象有助于慢性阑尾炎的诊断。     

儿童急性阑尾炎的MSCT表现

目的:探讨儿童急性阑尾炎的MSCT表现,以提高该病的诊断水平。方法:回顾性分析44例经手术病理证实的儿童急性阑尾炎的MSCT征象。结果:44例中,急性单纯性阑尾炎9例,伴粪石7例,MSCT示阑尾外径增宽,管壁略肿胀,边缘不清;急性化脓性阑尾炎19例,伴粪石12例,穿孔4例,MSCT示阑尾外径明显增宽,管壁肿胀,管腔内积液,并发阑尾穿孔时管壁连续性中断;急性坏疽性阑尾炎16例,伴粪石14例,穿孔14例,MSCT示阑尾管壁明显增厚,管腔周围有积液积气,邻近盲肠壁增厚,边界模糊。结论:儿童急性阑尾炎有一定的CT特征,可为制订临床治疗方案提供依据。     

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 经临床确诊的49例急性阑尾炎的CT表现进行回顾性分析。结果 阑尾肿大增粗9例，阑尾盲肠周围炎21例，阑尾周围脓肿19例，27例中有39个粪石，右侧结肠旁沟积液14例，右侧腰大肌影模糊8例。结论 螺旋CT是诊断急性阑尾炎的有效手段，尤其能为临床合理治疗提供有利的帮助。     

256层螺旋CT对成人穿孔型急性阑尾炎的诊断价值

目的探讨成人穿孔型急性阑尾炎的256层螺旋CT影像学特征,并对其征象进行全面分析,以期提高对该病的影像诊断准确率,并探索256层CT在成人穿孔型阑尾炎诊断中的应用价值。方法回顾经手术证实的成人穿孔型急性阑尾炎35例,对其主次要征象进行分析总结,并与166例非穿孔型急性阑尾炎进行影像学对照。结果成人穿孔型急性阑尾炎的主要征象为阑尾腔外游离气体及腔外粪石,发生率分别为28.5%及5.7%,腔外气体均较少,最大深度均不超过4.7mm,最大长度不超过4.9mm,腔外粪石平均直径3mm。与非穿孔型急性阑尾炎相比,次要征象阑尾周围脓肿的发生率明显增高,阑尾周围炎发生率及程度均较严重。结论阑尾腔外气体及腔外粪石是成人阑尾炎穿孔的重要诊断依据,在主要征象不明显时,发现阑尾周围脓肿及严重的阑尾周围炎则可高度提示阑尾炎已发生或将要发生穿孔的可能。256层螺旋CT在诊断穿孔型阑尾炎方面具有重要临床应用价值。     

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。     

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。     

钼靶X线、彩色多普勒超声对乳腺结节诊断的临床应用价值

目的：评价钼靶X线与彩色多普勒超声（color Doppler ultrasonography，CDUS）对乳腺结节诊断的临床应用价值。方法：对126例经钼靶X线、CDUS检查的乳腺结节资料进行分析比较，并与术后病理结果对照。结果：126例乳腺结节有76例良性病变，钼靶X线诊断正确66例，CDUS诊断正确68例（X2=0．07，P〈0.05），钼靶X线＋CDUS诊断正确71例。有50例恶性病变，钼靶X线诊断正确46例，超声诊断正确36例（X2=3．87，Pd0．05），钼靶X线＋CDUS诊断正确49例。结论：在乳腺结节良性病变诊断中，钼靶X线与CDUS无明显统计学差异，但对乳腺恶性肿块的检出，CR钼靶较CDUS有明显优势，二者联合诊断乳腺疾病的准确率高于两种方法单独使用，在乳腺疾病的检查中可以发挥优势互补的作用。     

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.     

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.     

Indium-111 leukocyte imaging in appendicitis

Indium-111-labeled leukocyte scintigraphy was applied to the diagnosis of acute appendicitis. Thirty-two patients observed in the hospital for possible appendicitis were prospectively studied. Scanning was done 2 hr after radiopharmaceutical injection. Thirteen scans were positive for acute appendicitis, and all but one were confirmed at laparotomy. In addition, two cases of colitis and two cases of peritonitis were detected. Of 15 negative studies, 11 had a benign course. Four patients with negative studies had laparotomy; two were found to have appendicitis and two had a normal appendix. Of 14 proven cases of appendicitis, 12 scans were positive for appendicitis with one false-positive scan, providing a sensitivity of 86%. Specificity was 93%: all negative cases except one had negative scans. Overall accuracy was 91% (29 of 32), comparing favorably with the accepted false-positive laparotomy rate of 25%. Use of In-111-labeled leukocyte scintigraphy serves to reduce the false-positive laparotomy rate and to shorten the clinical observation time in patients with acute appendicitis.     

The impact of ultrasound in suspected acute appendicitis

AIMS: To evaluate prospectively the impact of an appendix ultrasound (US) service on the clinical management of patients presenting with suspected acute appendicitis. MATERIALS AND METHODS: The referring clinician completed a proforma for patients presenting with suspected acute appendicitis. Two visual analogue scales assessed clinical suspicion before and after knowledge of laboratory results. The clinician also indicated if they intended to operate had US been unavailable. During a 3-year period, 327 patients were examined by graded-compression US and diagnosed "positive" or "negative" for acute appendicitis. Findings were correlated with histopathology results. The referring clinician completed a retrospective audit questionnaire to assess user satisfaction. RESULTS: Clinical suspicion was altered by knowledge of laboratory results. The decision to operate if US had been unavailable, was "yes" in 70 cases (group A), "no" in 231 (group B), and incomplete in 26 (group C). In group A, 31 patients (44.3%) had a negative US and 25 avoided surgery. US identified 39 cases of appendicitis and 37 appendicectomies confirmed appendicitis in 34 cases. In group B, 72 (31.2%) patients had a positive US and 66 appendicectomies confirmed 51 cases of appendicitis. The sensitivity of US was 94.7% in group A, 93.3% in group B and 93.8% overall. Specificity was 90.6% in group A, 91.2% in group B and 91.3% overall. US findings were contrary to intended surgical management in 103 cases. Management was altered in 97 cases (32.2%), with a positive outcome in 85 (28.2%). The referrers found US of appendix very useful in planning appropriate management. CONCLUSION: US of the appendix increases diagnostic accuracy, alters management and is more sensitive and specific than clinical impression, either alone, or in conjunction with laboratory results.     

Presence or absence of gas in the appendix: additional criteria to rule out or confirm acute appendicitis--evaluation with US

PURPOSE: To investigate whether the presence or absence of gas in the appendix may be considered as additional ultrasonographic (US) criteria to rule out or confirm acute appendicitis. MATERIALS AND METHODS: The appendices in 239 control subjects, 138 patients with lower right quadrant pain without acute appendicitis, and 80 patients with acute appendicitis were prospectively evaluated for intraluminal gas with US. RESULTS: The appendices in 206 (86%) control subjects showed gas at US, and those in 33 (14%) did not. The appendices in 109 (79%) symptomatic patients without acute appendicitis showed gas, and those in 29 (21%) did not. The appendices in 12 (15%) patients with acutely inflamed appendices showed gas, and those in 68 (85%) did not. The absence of gas as a criterion for acute appendicitis had a sensitivity of 85%; specificity, 79%; positive and negative predictive values, 57% and 94%, respectively; and accuracy, 81%. Gas was useful to exclude acute appendicitis in 64 (46%) symptomatic patients because the established criteria were misleading. In 19 (24%) patients, the absence of gas was useful for diagnosis of acute appendicitis because the other criteria were not convincing. CONCLUSION: US-based detection of gas in the appendiceal lumen helps to rule out acute appendicitis, whereas the absence of gas further confirms its presence, especially in cases where established US criteria are either insufficiently present or misleading.     

Primary neoplasms of the appendix manifesting as acute appendicitis: CT findings with pathologic comparison

PURPOSE: To evaluate the computed tomographic (CT) findings in patients with acute appendicitis related to an underlying appendiceal neoplasm. MATERIALS AND METHODS: Clinical and pathologic data obtained over a 10-year period in 65 patients with primary appendiceal neoplasms were reviewed. Preoperative CT studies in patients who presented clinically with symptoms of acute appendicitis were analyzed retrospectively and in consensus by three radiologists. The appendix was evaluated on CT scans for morphology, location, presence of calcification, maximal diameter, and wall thickness. RESULTS: Twenty-six (40%) of the 65 patients with appendiceal neoplasms had presented with symptoms of acute appendicitis. Preoperative CT studies available in 22 patients showed increased appendiceal diameter, wall thickening, and periappendiceal fat stranding in 22 (100%), 22 (100%), and 21 (95%) patients, respectively. The appendiceal diameter was greater than 15 mm (mean diameter, 2.9 cm) in 19 patients (86%). Morphologic changes of concern for neoplasm were present in 19 patients (86%) and included cystic dilatation in nine patients and presence of a soft-tissue mass without dilatation in 10 patients. An appendiceal diameter greater than 15 mm and/or a morphologic abnormality were present in 21 of 22 cases (95%). CONCLUSION: CT findings strongly suggest the presence of underlying neoplasm in the majority of patients with secondary appendicitis.     

Efficiency of unenhanced MRI in the diagnosis of acute appendicitis: Comparison with Alvarado scoring system and histopathological results

Purpose

The purpose of this study was to assess the diagnostic value of unenhanced magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis and compare with Alvarado scores and histopathological results.

Materials and methods

The study included 85 consecutive patients (mean age, 26.5 ± 11.3 years) who were clinically suspected of having acute appendicitis. Each patients Alvarado scores were recorded and unenhanced MRI was performed, consisting of T1-weighted, T2-weighted and fat-suppressed T2-weighted fast spin-echo sequences. The MR images were prospectively reviewed in consensus for the presence of acute appendicitis by two radiologists who were blinded to the results of the Alvarado scores.The study population were divided into three subgroups based on the MRI findings: Group I: definitely not appendicitis, Group II: probably appendicitis, Group III: definitely appendicitis. All patients were divided into two subgroups according to Alvarado scores as Group A (low: 1-6), and Group B (high: 7-10). MR findings were compared with Alvarado scores and histopathological findings.

Results

Sixty-six (77.6%) of the 85 patients with clinically suspected acute appendicitis, had undergone surgery. The diagnosis of appendicitis could be correctly achieved with MRI in 55 (83.3%) of 57 (86.4%) patients with histopathologically proven acute appendicitis. The sensitivity, specificity, positive predictive value and negative predictive value of MRI examination and Alvarado scoring system in the diagnosis of acute appendicitis were 96.49%, 66.67%, 94.83%, 75.0% and 84.21%, 66.67%, 94.12%, 40.0%, respectively.

Conclusions

MRI is a valuable technique for detecting acute appendicitis even in the cases with low Alvarado scores. To increase the diagnostic accuracy and preventing unnecessary laparotomies for suspected appendicitis, shorter and cheaper unenhanced basic MRI may be performed.     

Role of color-Doppler sonography in the follow-up of renal artery stenting

PURPOSE: The aim of this study was to evaluate the utility of color-Doppler ultrasound (CDUS) in detecting haemodynamically significant in-stent restenosis in patients who underwent endoluminal renal artery revascularisation by stent deployment. MATERIALS AND METHOD: Between January 2000 and December 2006, 42 patients (nine women and 33 men, age range 45-87 years) treated by endovascular renal artery stenting were studied with CDUS. Renal artery haemodynamics were evaluated to identify haemodynamically significant restenosis. Patients with CDUS signs of restenosis underwent angiography for a possible further revascularisation procedure. RESULT: Of 42 patients examined by CDUS, 13 (31%) showed signs of haemodynamically significant in-stent renal artery restenosis. Of these 13, three did not undergo endoluminal renal artery revascularisation because renal ischaemia deterioration and irreversible renal circulation impairment. In the remaining ten patients (23.8%), who had no signs of severe nephropathy, angiography confirmed the CDUS findings of in-stent restenosis in all cases. Restenoses were successfully treated by a repeat endovascular revascularisation procedure. CONCLUSION: Our results confirm the fundamental role of CDUS in the follow-up of patients after renal artery stenting. It enables early restenosis detection and evaluation of renovascular disease associated with renal artery stenosis. CDUS provides essential information for the subsequent clinical management of these patients.