螺旋CT多平面重建对临床不典型阑尾炎的诊断价值

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

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CTMPR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。

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 nansaxial 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%0. 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.