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.     

螺旋CT扫描对穿孔与非穿孔性阑尾炎的鉴别诊断价值

目的：评价螺旋CT扫描对穿孔与非穿孔性阑尾炎的鉴别诊断价值.方法：对116例手术、病理证实的阑尾炎患者的CT资料进行分析.116例中,45例并发阑尾穿孔（穿孔组）,71例未发生穿孔（非穿孔组）.结果：阑尾脓肿、蜂窝织炎、阑尾腔外积气和腔外结石4种征象对诊断阑尾穿孔的敏感度分别为42.2%、51.1%、15.6%和8.9%,特异度除蜂窝织炎为94.4%外,其余均为100%.CT诊断阑尾炎穿孔总的敏感度93.3%,特异度94.4%,诊断符合率为94%.此外,穿孔组患者的平均年龄和阑尾横径均大于非穿孔组者.结论：仔细观察有无阑尾脓肿、蜂窝织炎、腔外积气、腔外结石等征象,对判断阑尾炎及是否并发穿孔具有较高的诊断价值.     

MRI鉴别穿孔与坏疽性急性阑尾炎价值的动物实验研究

目的:研究MRI在穿孔与坏疽性急性阑尾炎中的鉴别诊断价值。方法:经手术和病理证实的12只穿孔性急性阑尾炎(PAA)及10只坏疽性急性阑尾炎(GAA)的新西兰大白兔进行MRI检查。观察如下MR征象:阑尾壁缺损,阑尾周围脓肿,阑尾腔外积气,阑尾周围蜂窝织炎。结果:PAA组与GAA组病例在阑尾壁缺损MRI征象发生率有统计学差异;阑尾壁缺损、阑尾周围脓肿、阑尾腔外积气征象出现至少一种特异性MRI征象对PAA诊断的敏感度、特异度和准确度分别为66.67%(8/12)、100%(10/10)和81.82%(18/22)。结论:MRI在PAA与GAA鉴别诊断方面具有较高的诊断价值。     

多层螺旋CT在穿孔性阑尾炎诊断中的价值

目的 探讨多层螺旋CT及图像后处理技术在穿孔性阑尾炎诊断中的价值.方法 36例穿孔性阑尾炎的病人行多层螺旋CT检查,并经工作站进行多层面重组(multiplanar reconstruction, MPR)、曲面重组(Curved planar reformation, CPR),分析其CT表现并与手术病理结果对照.结果 穿孔性阑尾炎CT征象有:阑尾周围脓肿27例;阑尾腔外积气7例;阑尾腔外结石9例,均与阑尾周围脓肿或阑尾腔外积气并存;蜂窝织炎5例;阑尾壁局限性缺损1例.多层螺旋CT对穿孔性阑尾炎诊断准确率为92%.结论 多层螺旋CT及图像后处理技术能多方位显示阑尾及其周围的病变,提高穿孔性阑尾炎术前诊断准确率.     

血吸虫性阑尾炎的CT表现

目的 探讨血吸虫性阑尾炎的CT表现.方法 搜集经手术病理确诊的血吸虫性阑尾炎17例,另随机选取30例非血吸虫性阑尾炎作为对照,对比分析两组CT表现并进行统计学处理.结果 血吸虫性阑尾炎组与非血吸虫性阑尾炎组间阑尾增粗、阑尾壁增厚、阑尾周围脂肪条纹影征象的出现率无统计学差异(P＞0.05).阑尾石征象在两组出现的概率无统计学差异(P＞0.05),但轨道状阑尾石更常见于血吸虫性阑尾炎(P＜0.05),结肠壁钙化也更常见于血吸虫性阑尾炎(P＜0.05).结论 CT平扫联合多平面重组(MPR)对血吸虫性阑尾炎有较高诊断价值,轨道状阑尾石及结肠壁连续性钙化有助于鉴别血吸虫性阑尾炎与非血吸虫性阑尾炎.     

阑尾腔内气体MDCT征象诊断阑尾炎的价值

目的 探讨阑尾腔内气体多排螺旋CT(MDCT)征象的分型,以及不同类型征象鉴别诊断阑尾炎和非阑尾炎的价值.资料与方法 回顾性分析经手术和临床随访证实的76例阑尾炎和59例非阑尾炎患者的MDCT影像表现,将其中45例阑尾腔内气体征象分为局限气体、连续气体、不连续气体3种类型,统计学分析不同类型的阑尾腔内气体征象鉴别诊断阑尾炎是否具有显著差异性.结果 阑尾腔内局限气体征象诊断阑尾炎的特异性不高(P＞0.05).但阑尾腔内连续气体征象在非阑尾炎组出现的概率明显高于阑尾炎组(P＜0.05),阑尾腔内不连续气体征象在阑尾炎组出现的概率明显高于非阑尾炎组(P＜0.05).结论 不同类型的阑尾腔内气体征象对鉴别诊断阑尾炎和非阑尾炎有较高的价值.     

阑尾石多排螺旋CT征象诊断阑尾炎的价值

目的 探讨阑尾石MDCT征象诊断阑尾炎的价值.方法 回顾分析经手术和临床随访证实的87例阑尾炎和55例非阑尾炎患者的MDCT影像表现.统计分析阑尾石征象与阑尾炎的关系.结果 阑尾石征象阳性43例(阑尾炎患者33例,非阑尾炎患者10例),诊断阑尾炎的准确性、敏感性和特异性分别为54.9%、37.9%和81.8%,在阑尾炎组和非阑尾炎组中出现的概率无显著差异性,亦不能鉴别阑尾炎的病理分型(P＞0.05).12例梗阻性阑尾石征象(短径≥5 mm,位于阑尾近端)多见于阑尾炎组,但不能鉴别阑尾炎病理分型(P＞0.05).5例腔外阑尾石征象仅见于坏疽性阑尾炎(P＜0.05).结论 梗阻性阑尾石征象有助于阑尾炎的诊断,腔外阑尾石征象诊断坏疽性阑尾炎存在较高的特异性价值.     

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诊断急性阑尾炎临床应用分析

目的探讨螺旋CT在急性阑尾炎诊断中的临床应用价值。方法对经手术确诊的50例急性阑尾炎患者的术前螺旋CT表现(包括直接征象及间接征象)与术中所见进行回顾性对比分析。结果 CT表现为阑尾增粗43例,管壁增厚33例,周围渗出改变48例,粪石20例,周围脓肿15例,穿孔7例,与手术所见极为相近。结论螺旋CT能准确显示急性阑尾炎的直接征象及间接征象,可明显提高术前诊断准确率。     

阑尾积液在CT诊断阑尾炎中的价值

目的 探讨阑尾积液在阑尾炎诊断中的价值.方法 收集经手术病理证实的42例阑尾炎,回顾性分析其CT表现.结果 在手术病理证实的42例中,35例表现阑尾增厚,壁增厚并强化,其中32例合并腔内积液,12例可见粪石,28例(含5例穿孔)表现阑尾周围或盆腔炎性改变.结论 在CT表现阑尾增粗的病例中,如果结合阑尾腔内积液(>2.6 mm),则诊断符合率明显提高,可达95%.     

Evaluation of perforated and nonperforated appendicitis with CT

Fifty-three patients with 38 cases of perforated appendicitis and 15 cases of appendicitis without perforation were evaluated based on the computed tomography (CT) appearances of appendiceal diameter, phlegmon, abscess, extraluminal air, appendiceal wall enhancement, lateroconal fascial thickening, appendicolith, bowel wall thickening, ascites, ileal wall enhancement, peritoneal enhancement, periappendiceal fluid, omental haziness, retrocecal appendix, intraluminal air, and the combination of intraluminal air and appendicolith. The result of appendiceal diameter was compared using two-sample Student's t test, and the other CT findings were analyzed by Fisher's Exact Test. Our results showed that appendix was larger in caliber in perforated appendix (P<.05). Direct CT signs (i.e., phlegmon, abscess, and extraluminal air) were more specific for perforated appendicitis (P<.05). Indirect signs (bowel wall thickening, ascites, ileal wall enhancement, intraluminal air, and combined intraluminal air and appendicolith) were also found in higher incidence in appendiceal perforation (P<.05). Appendiceal enlargement and ileal wall enhancement were the two predominant findings in one case of perforation. We concluded that direct and indirect CT appearances can differentiate appendicitis with and without perforation. Indirect signs may be helpful in difficult case.     

Differentiation of perforated from nonperforated appendicitis at CT

PURPOSE: To evaluate the sensitivity and specificity of five computed tomographic (CT) criteria in the differentiation of perforated from nonperforated appendicitis. MATERIALS AND METHODS: CT scans of 94 patients with surgically proven appendicitis were classified on review as showing perforation if one of five CT findings was present. The authors calculated the sensitivity and specificity for each finding by comparing the predicted outcome to the surgical and pathologic outcome. RESULTS: The perforated group comprised 39 patients and the nonperforated group comprised 55 patients. Sensitivity for abscess, phlegmon, extraluminal air, extraluminal appendicolith, and focal defect in enhancing appendiceal wall individually were 36%, 46%, 36%, 21%, and 64%, respectively. Sensitivity for any one of the five findings was 94.9%. Specificities were 100% for all findings except for phlegmon (95%). Groups differed with respect to age: 47 years +/- 19 (mean +/- SD) for perforated appendicitis and 30 years +/- 13 for nonperforated appendicitis (P <.001). Groups also differed with respect to appendiceal diameter: 15 mm +/- 4.9 for perforated appendicitis and 12 mm +/- 3.3 for nonperforated appendicitis (P =.049). CONCLUSION: A dedicated search for five specific CT findings allowed an overall sensitivity of 94.9% for perforated appendicitis. Among findings with 100% specificity, a focal defect in the enhancing appendiceal wall achieved the highest sensitivity.     

A retrospective study of CT findings in cases undergoing appendectomy at a single hospital

The purpose of this study was to determine which clinical information or computed tomography (CT) features can distinguish perforated from nonperforated appendicitis. We collected data from 102 patients (62 men, 40 women; mean age, 49.6 years; age range, 16-85 years) who presented to the emergency department with acute abdominal pain or suspicion of acute appendicitis and underwent appendectomy. In the clinical information, there was no significant factor to predict appendiceal perforation. As for CT features, significant imaging factors for predicting appendiceal perforation included abscess, phlegmon, and thickening of lateroconal fascia. The treatment strategy of acute appendicitis varies according to the integrity of the appendiceal wall. Besides clinical findings, CT features can distinguish perforated from nonperforated appendicitis, facilitating proper decision making in ER.     

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.     

Perforated versus nonperforated acute appendicitis: accuracy of multidetector CT detection

PURPOSE: To retrospectively evaluate the accuracy of multidetector computed tomography (CT) in the diagnosis of perforated acute appendicitis by using surgery and pathologic examination combined as the reference standard. MATERIALS AND METHODS: The study was institutional review board approved and HIPAA compliant. Informed patient consent was waived. The authors retrospectively identified 244 patients (150 male, 94 female; mean age, 32.8 years; age range, 4-83 years) with pathologically proved acute appendicitis who underwent abdominopelvic multidetector CT. Two radiologists reviewed in consensus the multidetector CT images obtained in all patients for various findings that may be associated with appendiceal perforation. For continuous variables, a comparison of means between the perforated and nonperforated groups was performed by using the Wilcoxon rank sum test. For categorical variables, the sensitivity and specificity of each CT finding for the diagnosis of perforated appendicitis were determined. RESULTS: The CT findings of abscess (99%), extraluminal gas (98%), and ileus (93%) had the highest specificities for appendiceal perforation; however, the sensitivities of these findings were low: 34%, 35%, and 53%, respectively. The appendix was larger in patients with perforated appendicitis: The mean diameter was 15.1 mm compared with a mean diameter of 11.7 mm in patients with nonperforated appendicitis (P < .001). Appendicolith, free fluid, enlarged abdominal lymph nodes, and enhancement defect in the appendiceal wall were neither highly sensitive nor highly specific for the detection of perforation. CONCLUSION: Although certain multidetector CT findings are very specific for the diagnosis of perforated appendicitis, overall multidetector CT sensitivity is poor. Unless abscess or extraluminal gas is present, multidetector CT cannot enable the diagnosis of perforation.     

Differentiation of nonperforated from perforated appendicitis: accuracy of CT diagnosis and relationship of CT findings to length of hospital stay

PURPOSE: To determine retrospectively the sensitivity and specificity of computed tomographic (CT) signs in differentiating acute nonperforated appendicitis from perforated appendicitis and to compare CT findings with the length of hospital stay. MATERIALS AND METHODS: Institutional Review Board approval was obtained for this study, and patient informed consent was obtained for record review for research purposes. Two radiologists were blinded to patient identification but were informed that all patients presented to the emergency department with abdominal pain and underwent appendectomy. Radiologists independently reviewed CT images of 86 consecutive patients (45 males, 41 females; mean age, 33.7 years; age range, 8.2-87.1 years) who presented to the emergency department with acute abdominal pain, who underwent CT after initial emergency department assessment, and who underwent appendectomy within the subsequent 24 hours. Individual findings and confidence level for the diagnosis of perforated appendicitis were noted. Consensus interpretation was performed with a third radiologist. The consensus CT findings were correlated with the surgical and pathologic findings by using chi(2) or Fisher exact tests for univariate analysis and logistic regression for multiple variable analysis. Wilcoxon rank sum tests were used to assess the association between consensus CT findings and length of hospital stay. RESULTS: Twenty-one (24%) of the 86 patients had appendiceal perforation. Extraluminal air and either moderate or severe periappendiceal inflammatory stranding were statistically significant independent predictors for perforation (P < .001). A focal defect in enhancing appendiceal wall was significantly associated with perforation (P < .001) and had a sensitivity of 58.8% and specificity of 85.7% on consensus review, with eight false-positive results. There was a strong association between the degree of periappendiceal inflammatory stranding and the length of hospital stay (P < .001). CONCLUSION: Extraluminal air and moderate or severe periappendiceal inflammatory stranding are statistically significant independent predictors for appendiceal perforation and are associated with increased hospital stay.     

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.     

阑尾黏液囊肿的CT诊断及良恶性鉴别

目的 探讨阑尾黏液囊肿的CT特征,并分析其良恶性鉴别要点.方法 回顾性分析经病理证实的31例阑尾黏液囊肿临床和影像资料,其中单纯性囊肿和黏液囊腺瘤为良性组,低级别黏液性肿瘤为交界组,黏液囊腺癌为恶性组.分组对照分析CT征象并行统计学分析肿块的大小(长径、短径)、囊壁(厚度、均匀度、光滑度)、囊内容物(壁结节、分隔、钙化、密度)、周围脂肪浸润、腹腔积液和腹膜假黏液瘤与良恶性的关系;计算单个或多个CT征象的灵敏度和特异度值.