螺旋CT多平面重建对临床不典型阑尾炎的诊断价值

目的:探讨螺旋CT多平面重建(MPR)对无典型临床表现阑尾炎的诊断价值.方法:搜集临床首次诊断未考虑为阑尾炎,手术和病理证实为阑尾炎者19例,回顾性分析比较螺旋CT轴扫和多平面重建(MPR)两种方法的诊断符合率.结果:8例表现为阑尾增粗、壁增厚并有明显强化,其中4例阑尾内见结石;盲肠和(或)周围炎10例;右下腹局限性脓肿5例,其中2例伴斑点钙化.采用螺旋CT轴扫法误诊为回盲部及升结肠肿瘤2例,盆腔炎1例,误诊率15.8%,诊断符合率84.2%.采用螺旋CT多平面重建法误诊为回盲部及升结肠肿瘤1例,误诊率5.3%,诊断符合率94.7%.结论:症状和体征不典型的阑尾炎临床诊断困难,易误诊,螺旋CT MPR方法简单,可从不同角度观察病变部位及其周围情况,有利于鉴别诊断,提高诊断符合率,具有较高的临床价值.

Appendicitis with Atypical Clinical Features:Spiral CT Assessment with Multiplanar Reconstruction Versus Transaxial CT

Objective:To compare the accuracy of spiral CT with multiplanar reconstruction (MPR) and with transaxial scanning in diagnosis of appendicitis with atypical clinical features.Methods:The accuracy of spiral CT with MPR and with transaxial scanning of 19 cases of surgically and pathologically confirmed appendicitis,which were not initially considered at clinical presentation were retrospectively compared.Results:With transaxial scanning 2 cases were misdiagnosed as tumor of ileocecum and ascending colon,and another case was misdiagnosed as pelvic inflammatory disease.The false negative rate was 15.8%,and the true positive rate was 84.2%.With MPR,1 case was misdiagnosed as tumor of ileocecum and ascending colon.The false negative rate was 5.3%,and the true positive rate was 94.7%.Conclusion:Spiral CT with MPR is of higher sensitivity than that with transaxial scanning alone in diagnosis of appendicitis with atypical clinical features and can decrease its false negative rate.