多层螺旋CT增强扫描及多平面重建诊断急性阑尾炎

Diagnosis of Acute Appendicitis by Contrast Enhanced Multi-slice CT with Multiplanar Reformation

目的:探讨无肠道准备的多层螺旋CT(MSCT)增强扫描及多平面重建(MPR)方案诊断急性阑尾炎(AA)的价值。方法:64例经手术和病理证实的AA患者行MSCT平扫和增强扫描,其中穿孔性急性阑尾炎(PAA)28例,非穿孔性急性阑尾炎(NPAA)36例(单纯性AA18例,AA伴周围炎18例)。用多平面重建(MPR)及曲面重建(CPR)相结合的方法完整地显示阑尾,观察、测量和比较MSCT平扫与增强扫描在诊断AA方面的差异。结果:对于单纯性AA和PAA的诊断和分型,MSCT增强方案明显优于平扫方案(P=0.000,0.000);对于AA伴周围炎,两者差异无明显统计学意义(P=1.000);MSCT增强方案诊断AA的准确性为95.3%(61/64),而平扫仅为56.3%(36/64)。结论:无肠道准备的MSCT增强方案是一种简便、快捷、准确的AA诊断方法,结合阑尾MPR重建可进一步提高诊断信心。

Purpose： To investigate the enhanced multi-slice CT （MSCT） with multiplanar reformation （MPR） in diagnosing acute appendicitis （AA） without administration of enteric contrast medium. Methods： Sixty-four patients with acute appendicitis proved by surgical and pathological results underwent abdomino- pelvic unenhanced and enhanced MSCT scan. The diagnosis of twenty-eight cases was perforated acute appendicitis （PAA） and thirty-six cases was non-perforated acute appendicitis （NPAA） （simple AA in 18 and AA associated with periappendiceal inflammation in 18）. The whole appendix was reconstructed by using MPR and curved multiplanar reformation （CPR） techniques based on raw data of the unenhanced and enhanced MSCT scans, respectively. The differences of the performance of the unenhanced and enhanced MSCT in diagnosing AA were compared. Results： For the diagnosis and classification of simple AA and PAA, the enhanced MSCT was superior to unenhanced MSCT （P=0.000, 0.000）. There was no significantly statistical difference between the unenhanced MSCT and the enhanced MSCT （p=1.000） in diagnosing AA associated with periappendiceal inflammation. The accuracy of the enhanced MSCT protocol was 95.3% （61/64） in diagnosing and classifying AA, whereas the unenbanced MSCT protocol was 56.3% （36/64） only. Conclusion： The enhanced MSCT without administration of enteric contrast medium is a simple, rapid and accurate protocol in diagnosing AA. Combining with MPR technique, it can further improve the diagnostic confidence.