The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT
The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT
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DOI：
10.1046/j.1600-0455.2003.00146.x
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发表时间：
2003-11-01
期刊：
影响因子：
1.3
通讯作者：
Chung, EC
中科院分区：
文献类型：
--
作者：
Choi, D;Park, H;Chung, EC
目的：探讨螺旋CT增强扫描对急性阑尾炎的诊断价值。材料与方法：回顾性分析71例经手术证实的急性阑尾炎患者及167例其他诊断的阑尾螺旋CT静脉造影剂扫描（腹部，7毫米准直；腹盆交界处，5毫米准直）。三位放射科医生分析了以下参数：阑尾增大（直径6mm）、阑尾壁增厚、阑尾壁增强、未见阑尾、阑尾结石、阑尾腔内空气、腔内空气、腔外空气、阑尾周围脂肪搁浅、腔外液体、痰、脓肿、淋巴结病、节段性回肠末端壁增厚、局灶性盲肠根尖增厚、局灶性结肠壁增厚、节段性结肠壁增厚。通过逐步logistic回归分析选择阑尾炎与其他诊断的最佳区分特征。结果：阑尾肿大（R = 0.739）、阑尾壁增厚（R = 0.525）、阑尾周围脂肪阻塞（R = 0.414）、阑尾壁强化（R = 0.404）、局灶性盲肠根尖增厚（R = 0.171）、阑尾结石（R = 0.157）、腔外空气（R = 0.050）、壁内空气（R = 0.043）、痰（R = 0.030）等9个CT表现与其他诊断相鉴别（P < 0.05）。阑尾肿大（敏感性93%，特异性92%）、阑尾壁增厚（敏感性66%，特异性96%）、阑尾周围脂肪搁浅（敏感性87%，特异性74%）、阑尾壁增强（敏感性75%，特异性85%）与急性阑尾炎的相关性在统计学上最为显著。结论：5 mm螺旋CT造影检查，阑尾肿大、阑尾壁增厚、阑尾周围脂肪堆积、阑尾壁强化是诊断急性阑尾炎最有用的表现。
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.