急性右下腹疼痛的MSCT诊断

Diagnosis and Different Diagnosis of MSCT in Acute Right Lower Quadrant Abdominal Pain

目的探讨多层螺旋CT(MSCT)在急性右下腹疼痛(right lower quardrant abdominal pain,RLQP)的诊断与鉴别诊断中的临床作用。方法对1167例RLQP患者采用GE Light Speed 16层、32层螺旋CT设备行CT检查(平扫942例,增强扫描225例),并采用最大密度投影(MIP)、多平面重组(MPR)及容积再现(VR)影像后处理技术进行三维成像。并将术前影像诊断结果与手术、病理或临床治疗随访结果进行对比。结果共发现RLQP病因患者真阳性1064例,假阳性8例,假阴性10例,真阴性85例。敏感性和特异性分别为99.06%和91.36%。其中,急性阑尾炎729例,右侧输尿管盆腔段结石273例;急性妇科疾病20例(急性盆腔炎7例,异位妊娠及黄体破裂出血各4例,子宫内膜异位3例,卵巢扭转2例合并畸胎瘤1例);恶性肿瘤15例(肠癌13例,小肠间质瘤1例,淋巴瘤1例);肠套叠9例(合并肠腺癌4例,息肉2例,淋巴瘤1例);盲结肠憩室伴炎症8例;急性肠系膜淋巴结炎5例;克罗恩病(Crohn)2例;回盲部异物1例;急性胰腺炎2例。结论 MSCT能多方位显示右下腹组织器官解剖结构关系及病理变化表现,能快速诊断急性RLQP病因,可作为除育龄期女性及儿童外大多数患者的首选检查方法。

Objective To evaluate the value of MSCT in diagnosis of the acute right lower quadrant abdominal pain.Methods GE light speed 16 and 32 layer CT was performed in 1167 patients with clinically acute right lower quadrant abdominal pain.942 patients underwent plain scan,and 225 patients underwent contrast enhancement scan,meanwhile acquire three-dimensional imagings by MIP、MPR、VR.CT findings were correlated with pathology、operation or follow-up after clinic treatment.Results CT showed 1064 true positive,8 false positive,10 false negative,and 85 true negative cases,sensitivity and specificity were 99.06 % and 91.39%,respectively.Of 1064 patients with acute right lower quadrant pain,729 were acute appendicitis;273 were Right urolithiasis.20 Acute gynecologic conditions（7 pelvic inflammatory、4 ectopic pregnancy、4 hemorrhagic follicular cyst of right ovary、3 endometrosis and 2 ovarian torsion,1 associated with teratoma）.15 malignancies（14 cecocolic carcinoma.1 ileal gastrointestinal stromal tumor and1 lymphoma）.9 intussusception（4 associated with adenocarcinomama、2 polypoid and 1 lymphoma）.8 right-sided colonic and cecal diverticulitis.5 acute mesenteric lymphadenitis.2 Crohn diseases.1 ingestion foreige body and 2 acute pancreatitis.Conclusion CT is favourable to diagnose or exclude acute abdomen for suggestible patients since it can identify the range,extend and cause of lesion,and provide valuable information for clinical diagnosis and treatment.It can be used as the prefered method to most patients except reproductive age women and children.