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.     

Use of ultrasonography in the diagnosis of acute appendicitis

To date, the diagnosis of acute appendicitis (AA) has been made primarily on clinical grounds and imaging techniques have been considered less useful. This paper is aimed at evaluating US utility in the diagnosis of AA. US scans of the appendix, after Puylaert, were obtained in 30 healthy subjects (group A), in 49 patients with recurrent pain in the iliac fossa (group B), and in 28 patients with clinical signs highly suggestive of AA (group C). In none of the subjects in group A was the appendix seen. Neither was it demonstrated in the patients in group B, all of whom underwent surgery and never presented with suppurating, phlegmonous, gangrenous, perforating AA and/or abscess. In the patients in group C, 20 of whom had a positive histology for AA, US demonstrated 17 true positive, 8 true negatives and 3 false negatives. We consider as useful in the diagnosis of AA the following US signs: 1) the appendix cannot be demonstrated, in which case AA is to be excluded; 2) the appendix can be seen and is still, non-compressible and exhibits thickened walls; 3) the appendix contains fecaliths. The latter 2 findings are suggestive of AA. Thus, US of the appendix is useful (100% specificity in group B) in excluding AA when clinical diagnosis is questionable, but the method proves less reliable (85% sensitivity in group C) when clinical presentation is more definite.     

Contrast-enhanced power Doppler US in the diagnosis of acute appendicitis

INTRODUCTION/OBJECTIVE: To determine the value of power Doppler (PD) ultrasonography (US) and contrast-enhanced power Doppler (CEPD) US in the diagnosis of acute appendicitis and the prediction of histopathologic stages. METHODS AND MATERIAL: 50 patients with suspected acute appendicitis were evaluated by the same radiologist with PD US and CEPD US. Air micro bubbles stabilized by a granulate of "galactose and palmitic acid" were used as a contrast medium for sonography with the concentration of 400 mg/ml. PD US and CEPD US results were later correlated with the surgical and histopathologic findings. PD US and CEPD US findings were considered positive for appendicitis; if there was depiction of hyperemia in the wall of the appendix or if there was depiction of prominent peripheral vascularity when compared with normal soft tissues; and negative if both hyperemia and peripheral hyperemia were not prominent. RESULTS AND DISCUSSIONS: Of the 50 patients, 35 patients had histopathologically proven acute appendicitis. CEPD US showed prominent hyperemia in the appendiceal vessels or feeding vessels of the inflamed appendix, and resistance index (RI) calculations were easier. There was statistically significant difference between mean RI values of the normal appendix, suppurative appendicitis and gangrenous appendicitis. PD US has accuracy of 80%, sensitivity of 74% and CEPD US has 98%, and 100% in the diagnosis of acute appendicitis. CEPD US identified 100% of suppurative appendicitis and gangrenous appendicitis. CONCLUSION: CEPD US is a promising method in the diagnosis of acute appendicitis and determination of the inflammation stage.     

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。     

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。     

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.     

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.     

Significance of size and location of appendicoliths as exacerbating factor of acute appendicitis

The aim of the present study was to investigate the significance of appendicoliths as an exacerbating factor of acute appendicitis using multivariate analysis. A total of 254 patients with pathologically proved acute appendicitis were enrolled in this retrospective study (male, 51 %; mean age, 40.1 years; range, 15–91 years). Two radiologists performed a consensus evaluation of preoperative CT images for the presence of appendicoliths in consensus. When there were appendicoliths, they assessed the number and location of appendicoliths, and measured the longest diameter of the largest appendicolith. Pathological diagnosis was used for the reference standard. The relationships of appendicoliths to gangrenous appendicitis and to perforated appendicitis were each assessed with multiple logistic regression models, which were adjusted for demographic and clinical characteristics of patients. Significant relationships were identified between gangrenous appendicitis and the presence of appendicoliths (OR, 2.2; 95 % CI, 1.2–4.0), the largest appendicolith more than 5 mm in the longest (OR, 3.0; 95 % CI, 1.6–5.7), and location of an appendicolith at the root of the appendix (OR, 2.0; 95 % CI, 1.1–3.8). Among the CT characteristics, the location of an appendicolith at the root of the appendix only showed significant relationship with perforated appendicitis (OR, 4.5; 95 % CI, 1.4–15.4). Size of the largest appendicolith and location of appendicoliths at the root of the appendix are exacerbating factors of 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.     

Is colour Doppler sonography a good method to differentiate normal and abnormal appendices in children?

AIM: To determine whether colour Doppler sonograms can be used to differentiate between the normal appendix and acute appendicitis. MATERIAL AND METHODS: This prospective study examined 50 consecutive children with suspected appendicitis using grey-scale and colour Doppler US. Appendicitis was diagnosed when the appendix diameter was greater than 6 mm. Blood flow on the appendiceal wall was measured and classified as non-existent (0 pixels), low (1-2), moderate (3-4) or abundant (>4). Likelihood ratios were calculated for each of these levels. The diagnosis of acute appendicitis was confirmed by pathological findings, and ruled out by clinical follow-up or pathological findings. RESULTS: Of the 50 patients examined, 24 had appendicitis and 26 had a normal appendix. For 25 of the patients with a normal appendix, appendicitis was ruled out by clinical follow-up, and for one patient, by pathological findings. The abnormal appendix was identified in all patients with appendicitis. In the group of 26 patients without appendicitis, the normal appendix was visualized in 23 cases, one of which was false positive (100% sensitivity, 96% specificity). Abnormal appendices showed moderate to abundant flow in 62% of the cases and non-existent or low flow in 38%. Normal appendices had non-existent or low flow in 82% of the cases, but moderate or abundant in 18%. Significant differences were only found when the number of pixels was >4. CONCLUSION: Although the vascularity of normal and inflamed appendices may be different, this difference was not a good diagnostic indicator of appendicitis.     

The nonvisualized appendix: incidence of acute appendicitis when secondary inflammatory changes are absent

OBJECTIVE: The objective of our study was to assess the importance of nonvisualization of the appendix and its association with acute appendicitis on helical CT when secondary inflammatory changes are absent. MATERIALS AND METHODS: After we received institutional review board approval, CT scans of 366 consecutive patients obtained for lower abdominal or right lower quadrant pain and to rule out appendicitis were retrospectively reviewed. Images were reviewed by an experienced abdominal radiologist and compared with the formal interpretation. The amount of right lower quadrant and pericecal fat was quantified on a scale of 0 (none) to 2 (abundant). Patients with a nonvisualized appendix and other findings compatible with acute appendicitis-such as abscess formation, localized perforation, periappendiceal fat stranding, or appendicolith-were excluded. RESULTS: The appendix could not be visualized by both reviewers in 46 (13%) of 366 cases. CT findings indicated another cause for the patient's symptoms in 12 cases (26%), including gastrointestinal and genitourinary processes. An alternate diagnosis was subsequently reached in 11 additional patients (24%) with follow-up imaging or clinical evaluation. Only one patient (2%) with a nonvisualized appendix had acute appendicitis, proven by surgical pathology. In this patient, there was paucity of fat in the right lower quadrant. CONCLUSION: In the absence of a distinctly visualized appendix and secondary inflammatory changes, the incidence of acute appendicitis is low. Nonvisualization of the appendix even when a small amount of fat is present in the right lower quadrant may safely exclude acute appendicitis if no secondary CT findings are present.     

Multidetector-row CT of the appendix in healthy adults

The purpose of this study is to characterize the caliber of the normal appendix and the effect of luminal content on appendiceal diameter in adults using thin section intravenous (IV) contrast enhanced multidetector-row computed tomography (MDCT). A retrospective review was conducted using the MDCT datasets from 82 adults being screened as potential renal donors. The four-channel CT technique included IV contrast and 1-mm collimation. Arterial phase scans were reviewed by two radiologists blinded to surgical history, to evaluate the following parameters related to the appendix: quality of visualization, origin and course relative to the cecum, maximum cross-sectional diameter of the lumen and luminal contents at the point of measurement, appearance of the periappendiceal fat, and presence of any luminal calcification. Medical records were reviewed to determine which subjects had reported a previous appendectomy or to confirm the absence of symptoms in any subjects with findings suspicious for appendicitis. The appendix was visualized in 72 of the 77 subjects who did not report an appendectomy (94%). The mean diameter of the collapsed appendix was 5 mm (range: 3–7 mm) and the air-distended appendix, 7 mm (range: 4–10 mm). Sixteen to 17% of the collapsed appendices measured 7 mm in diameter. Minimal periappendiceal stranding was identified in 2/72 subjects (3%). Chart notes from within 24 h of the MDCT confirmed no signs or symptoms of appendicitis in cases that demonstrated any CT finding suspicious for appendicitis. In this healthy, adult population, the collapsed appendix measured up to 7 mm at MDCT. Air distention of the lumen results in a wider diameter, up to 10 mm.     

MR imaging of the normal appendix and acute appendicitis

PURPOSE: To describe the MR appearance of the normal appendix and the MR imaging characteristics of acute appendicitis with correlation to pathological severity. MATERIALS AND METHODS: A total of 20 volunteers participated in this study to demonstrate normal appendices by MR imaging. A total of 37 consecutive patients with clinically diagnosed acute appendicitis were also scanned. T1-weighted (T1WI) spin-echo images, T2-weighted (T2WI) fast spin-echo, and fat-suppressed spectral presaturation inversion recovery T2-weighted (T2SPIR) fast spin-echo images were obtained. The MR criteria for considering acute appendicitis were as follows: 1) thickening of the appendiceal wall with high intensity on T2WI or T2SPIR; 2) dilated lumen filled with high intensity material on T2WI or T2SPIR; and 3) increased intensity of periappendiceal tissue on T2WI or T2SPIR. RESULTS: The visibility of a normal appendix on MR imaging was 90% (18/20). It appeared as a cord-like structure of medium intensity without fluid collection in the lumen. A total of 30 cases with clinically diagnosed acute appendicitis had positive MR findings and all except one were pathologically proven. The one had cecal diverticulitis. These cases demonstrated filled lumen, with a hypointense wall on T1WI and slightly hyperintense on T2WI or T2SPIR. MR findings correlated well with pathological severity, especially a thicker wall, periappendiceal high intensity, and ascites were useful for suspecting severe appendicitis. CONCLUSION: Correct diagnosis of acute appendicitis was obtained with MRI, and correlated well with its pathological severity. MRI is a powerful alternative for diagnosing acute appendicitis especially for the patients in whom the radiation is major concern.     

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.     

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.     

Relative CT number of periappendiceal fat stranding may be an applicable index for estimating the severity of acute appendicitis

Objectives:To investigate the feasibility of relative CT numbers to periappendiceal fat attenuation as an applicable index for estimating the severity of acute appendicitis.Methods:In total, 308 consecutive surgery-confirmed acute appendicitis patients and 243 controls with available preoperative CT were analyzed retrospectively. The radiological parameters were appendix diameter, length, and wall thickness as concurrent appendicitis signs. CT numbers of periappendiceal fat, mesenteric fat, subcutaneous fat in the anterior and posterior abdominal wall, retroperitoneal fat, gluteal subcutaneous fat and psoas major muscle were measured, as well as the relative CT numbers of periappendiceal fat compared with other locations.Results:There were 287 suppurative acute appendicitis (SAA) and 21 gangrenous or perforated acute appendicitis (GPAA) cases confirmed by pathology. The CT number of periappendiceal fat was significantly higher in patients than in controls (P＜0.01) although there was a wide overlap (−72.33 HU–117.43 HU). Significant differences in relative CT numbers were observed between the groups in gluteal subcutaneous fat (R_CTgl) and psoas major muscle (R_CTps) (P＜0.01). The AUCs of R_CTgl and R_CTps showed high accuracy to discriminate acute appendicitis from controls (AUC = 0.803, 0.761; 0.854, 0.847) and GPAA from SAA (AUC = 0.905, 0.851).Conclusions:Attenuation of periappendiceal fat on CT is related to the severity of appendicitis, and relative CT numbers (R_CTgl and R_CTps) could be an applicable index for severity determination.Advances in knowledge:Periappendiceal fat infiltration is related to the severity of acute appendicitis (especially relative CT number). Other clinical and CT features also need to be considered in the evaluation of inflammation.     

腔内凸阵探头在急性阑尾炎诊断中的临床价值

目的:探讨腔内凸阵探头在急性阑尾炎诊断中的临床价值。方法:分别用腹部低频凸阵探头、高频线阵探头、腔内凸阵探头对54例临床可疑急性阑尾炎患者进行检查,首先判断阑尾及其位置,再根据阑尾管径及长径、管壁回声及腔内回声、肠系膜淋巴结有无肿大、阑尾周围有无积液等改变诊断阑尾炎,并将检查结果与手术病理结果对比。结果:经腹部低频凸阵探头诊断急性阑尾炎28例,漏诊20例,诊断符合率为58.3%,排除急性阑尾炎4例;高频线阵探头诊断急性阑尾炎43例,漏诊5例,诊断符合率为89.6%;腔内凸阵探头诊断急性阑尾炎42例,漏诊6例,诊断符合率为87.5%,排除急性阑尾炎3例。结论:腔内凸阵探头既可定位诊断阑尾的位置,了解阑尾与周围脏器的关系及病变情况,减少误诊、漏诊率,也可定性诊断阑尾的严重程度,对诊断急性阑尾炎有较高的临床价值。     

MDCT在探讨急性阑尾炎位置与周围渗出关系中的作用

目的：采用MDCT探讨急性非穿孔性阑尾炎解剖学位置与周围渗出的关系。方法：回顾性分析本院2010年-2012年经手术及病理证实的56例急性非穿孔性阑尾炎伴周围渗出的病例,采用MDCT对阑尾的解剖学位置进行分型,并对其炎症渗出的解剖学问隙进行分类,探讨其相互关系。结果：56例急性阑尾炎中,按影像学分型共发现腹膜腔型阑尾炎24例,盆腔型阑尾炎20例,腹膜后型12例。腹膜腔型阑尾炎共发现肠系膜窦积液9例,结肠旁沟积液3例,盆腔积液14例,腹膜后积液1例;盆腔型阑尾炎中,20例均出现盆腔积液,2例出现右侧肠系膜窦积液,2例见腹膜后积液。腹膜后型阑尾炎中,12例均出现腹膜后积液,2例伴有盆腔积液,1例伴有右结肠旁沟积液。其中3种类型阑尾炎的右结肠旁沟积液发生率间差异无统计学意义（P值均〉0．05）;腹膜后型与盆腔型阑尾炎的右肠系膜窦积液发生率间差异无统计学意义（P〉0．05）;腹膜腔型阑尾炎与盆腔型阑尾炎的腹膜后间隙积液发生率间差异无统计学意义（P〉0．05）;余右肠系膜窦、右结肠旁沟、腹膜后间隙及盆腔积液在各型阑尾炎发生率的差异均有统计学意义（P值均〈0．05）。结论：急性非穿孔性阑尾炎伴周围渗出根据其解剖位置有其特定的渗出范围,MDCT能对急性阑尾炎解剖学位置及周围渗出做出准确的诊断,可为临床手术提供指导。     

多层螺旋CT在急性阑尾炎诊断中的应用价值

目的：探讨多层螺旋 CT 在急性阑尾炎诊断中的应用价值。方法选取30例急性阑尾炎患者作为研究组和30例无任何症状的健康成人作为对照组进行多层螺旋 CT 检查。测量阑尾外径,观察阑尾位置,阑尾腔内液体密度、气体密度,阑尾周围脂肪密度改变及腹膜增厚、腹腔积液等并发表现。结果急性阑尾炎平均阑尾外径为(9.78±2.33)mm,健康成年人平均阑尾外径为(5.05±0.53)mm,二者差异有统计学意义(t=24.85,P <0.01)。阑尾周围组织脂肪密度增高、毛糙25例,占83.33%,CT 值约-40~20 HU;阑尾周围有渗出性改变伴腹膜增厚13例,占43.33%;阑尾管壁增厚、水肿29例,占96.67%;阑尾腔内高密度粪石9例,占30.00%;阑尾炎合并肠梗阻1例(占3.33%);阑尾炎患者并发有腹膜增厚,占80.00%;合并有腹腔积液,占23.33%。结论多层螺旋 CT 全腹部平扫可应用于急性阑尾炎的诊断;当阑尾外径 CT 表现为≥6 mm,阑尾腔积液、腔内粪石、周缘脂肪密度增高、腹膜增厚、腹腔积液等征象,可提示阑尾炎诊断。