穿孔性阑尾炎CT征象

目的 探讨阑尾穿孔具有诊断价值的CT征象。方法 回顾性分析205例经手术病理证实的穿孔性和非穿孔性阑尾炎患者的CT图像。观察12项急性阑尾炎的CT征象,采用χ²检验筛选可用于鉴别诊断穿孔性与非穿孔性阑尾炎的CT征象,评价这些征象的敏感度、特异度和准确率。采用Logistic回归分析法分析阑尾穿孔最具诊断价值的CT征象。结果 205例中,40例(40/205,19.51%)阑尾穿孔与165例(165/205,80.49%)阑尾未穿孔患者间,脓肿、阑尾壁强化缺损、蜂窝织炎、阑尾腔外积气、阑尾腔外粪石差异均有统计学意义(P均<0.05),各征象鉴别诊断穿孔性和非穿孔性阑尾炎的敏感度、特异度和准确率依次分别为:脓肿80.00%(32/40)、97.58%(161/165)、94.15%(193/205),阑尾壁强化缺损50.00%(20/40)、98.79%(163/165)、89.27%(183/205),蜂窝织炎37.50%(15/40)、95.76%(158/165)、84.39%(173/205),阑尾腔外积气27.50%(11/40)、99.39%(164/165)、85.37%(175/205),阑尾腔外粪石5.00%(2/40)、100.00%(165/165)、81.46%(167/205),Logistic回归分析显示脓肿、阑尾壁强化缺损与阑尾穿孔相关(Wald=33.21、16.19,P均<0.001)。结论 脓肿、阑尾壁强化缺损是阑尾穿孔最有诊断价值的CT征象。

CT findings of perforated appendicitis

Objective To explore the necessary CT findings for diagnosing perforated appendicitis. Methods CT images of 205 patients with acute appendicitis confirmed pathologically were reviewed retrospectively. CT findings of acute appendicitis were classified into twelve catogories. Chi-square test was performed to select CT findings which can be used to distinguish perforated from nonperforated appendicitis, and then their sensitivity, specificity and accuracy were analyzed. The stepwise Logistic regression analysis was performed to find out the valuable findings. Results In 205 cases, the differences of following five findings were statistical significance between patients with perforated appendicitis (40/205, 19.51%) and patients with nonperforated appendicitis (165/205, 80.49%; all P<0.05), and their sensitivity, specificity and accuracy as followed, i.e. abscess (80.00%, 97.58%, 94.15% ), enhancement defect in appendiceal wall (50.00%, 98.79%, 89.27% ), phlegmon (37.50%, 95.76%, 84.39% ), appendiceal extraluminal air (27.50%, 99.39%, 85.37% ), external coprolith of epityphlon (5.00%, 100%, 81.46% .The abscess and enhancement defect in appendiceal wall showed statistically significant association with perforated appendicitis on Logistic regression analysis (Wald=33.21, 16.19, both P<0.001). Conclusion Abscess, enhancement defect in appendiceal wall are the most valuable findings for diagnosing perforated appendicitis.