急性阑尾炎的CT漏诊及误诊分析

Analysis of Misinterpretation of Acute Appendicitis on CT

目的:探讨急性阑尾炎CT诊断漏诊、误诊的原因。材料和方法:对23例经手术及病理证实的急性阑尾炎病例的术前CT资料进行回顾性分析,重点对CT漏诊、误诊原因进行分析。结果:23例急性阑尾炎中,14例(60.9%)CT于术前确定急性阑尾炎诊断,8例(34.8%)漏诊,1例(4.3%)误诊。8例漏诊中,5例诊断时对急性阑尾炎CT表现认识不足或完全忽略;2例分别为单纯性阑尾炎及慢性阑尾炎急性发作,CT表现轻微;3例右下腹缺乏脂肪比衬,影像学诊断困难;2例CT扫描范围不足,未完全覆盖病变区域。1例阑尾脓肿因忽略脓腔中粪石征而误诊。结论:熟悉急性阑尾炎的各种CT表现、改善扫描方法并密切结合临床应可帮助提高术前诊断率。

Purpose： To analyze the reasons causing misinterpretation of acute appendicitis on CT. Materials and Methods＇. We retrospectively analyzed the preoperative CT data of 23 cases of acute appendicitis proved by surgery and pathology. Reasons causing misinterpretation of CT were intentionally analyzed. Results： In the 23 cases, 14 diagnosis （60.9%）were confirmed, 8 （34.8%）missing and 1 （4.3%）misdiagnosing. In the 8 cases with CT missing correct diagnosis pre - operation, the abnormal CT signs were not sufficiently realized or completely neglected in 5 cases; CT signs were mild in 2 cases which were simple acute appendicitis and chronic appendicitis with acute onset respectively; CT diagnoses were difficult to made in 3 cases lack of peritoneal fat; CT scans did not cover the whole area of lesion in 2 cases. 1 case of appendiceal abscess was misdiagnosed without noticing the fecalith in the abscess cavity. Conclusion： Being familiar with CT signs of acute appendicitis, improving CT scanning method and combining clinical history tightly would improve correct CT diagnosis before operation.