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.

Magnetic Resonance Imaging in the Diagnosis of Acute Appendicitis

Objective To evaluate the MRI diagnostic methods of acute appendicitis using MRI best sequence,and provide general surgery preoperative diagnosis. Materials and Methods A total of 41 cases of suspected acute appendicitis were reviewed using MRI scans in which 4 types of dedicated MRI sequences were designed. Results Cases with simple acute appendicitis showed a T_2 signal higher at the level of the appendiceal wall, with local fluid around the appendix. Cases with purulent appendicitis showed an increased T_2 signal in the cavity of the appendix ,along with a thickening of the appendiceal wall,or increased T_2 signals around effusions in cases with gangrenous appendicitis. Periappendiceal abscess showed a localized,high signal fluid collection that may have had extensive effects on the adjacent bowel loops,and into which the entire appendix may disappear. In addition, MRI and surgical findings had a 100% match in both the location and orientation of the appendices. Conclusion MRI techniques are capable of demonstrating the location of the appendix,the presence and stage of acute appendicitis and its complications.