多层螺旋CT增强检查诊断坏疽性阑尾炎的价值

Diagnostic Value of Enhanced Multidetector Helical CT in Gangrenous Appendicitis

目的提高坏疽性阑尾炎的CT诊断水平。方法选取我院2006年5月至2009年8月经手术病理证实的18例坏疽性阑尾炎患者,分析其CT表现并与病理结果对照。结果阑尾管壁增厚10例(56%)、管壁变薄4例(22%)、阑尾未显示4例(22%);阑尾管壁增厚者增强后管壁呈不连续强化,阑尾管壁变薄者增强后管壁无强化;CT平扫显示管壁缺损9例(50%),增强后显示阑尾管壁缺损13例(72%);阑尾周围及腹盆腔脓肿13例(72%),管腔外积气13例(72%),阑尾粪石12例(67%),阑尾腔外粪石4例(22%)。结论阑尾管壁无强化或不连续强化、缺损是坏疽性阑尾炎的直接征象,增强CT检查在发现早期坏疽性阑尾炎上有价值。阑尾周围/腹盆腔脓肿、管腔外积气及阑尾腔外粪石是坏疽性阑尾炎特异征象。

Objective To improve diagnostic level of gangrenous appendicitis with multidetector helical CT. Methods Eighteen patients with gangrenous appendicitis were collected after confirmed by surgery and histopathological examination. CT findings were analyzed and compared with pathologic parameters. Results Appendical wall thickening were 10 cases（56%）and appendical wall thinning were 4 cases （22%）,appendix was not visible in 4 cases（22%）. Appendical wall had discontinuous enhancement after administration of intravenous contrast material in those with appendical wall thickening. Appendical wall had not enhancement in those with appendical wall thinning. Appendical wall had defect in 9 cases（50%）on unenhanced CT examination and in 13 cases（72%）on enhanced CT examination .Abscess around appendix or in peritoneo-pelvic cavity was present in 13 cases（72%）. Extraluminal gas was present in 13 cases（72%）. Appendicolith was present in 12 cases（67%）and located outside appendical lumen in 4 cases（22%）. Conclusion No enhancement,discontinuous enhancement or wall defect of appendical wall is a direct sign of gangrenous appendicitis. Enhanced CT examination is valuable in finding earlier gangrenous appendicitis. Abscess around appendix or in peritoneo-pelvic cavity,extraluminal gas,appendicolith outside appendical lumen were specific signs of gangrenous appendicitis.