64层螺旋CT多期增强扫描对坏疽阑尾的早期诊断

The early diagnostic value of 64-slice Spiral CT in gangrenous appendicitis

目的应用64层螺旋CT多期增强扫描分析坏疽阑尾的影像特点及诊断价值,进一步提高对坏疽阑尾的诊断水平。方法回顾性分析经病理证实为急性阑尾炎并且有完整影像及临床资料、符合纳入标准的患者90例,分为坏疽组26例,非坏疽组64例,采用盲法对纳入病例的影像图像进行分析,主要观察阑尾特点、炎症表现及并发症,并分析各征象的诊断准确性及组间差异。结果阑尾坏疽发生率为28.9%,主要表现为阑尾周围炎、肠壁局限性强化减弱、肠外积气及肠壁积气、阑尾动脉不显示(P<0.05)。局限性强化减弱、肠壁积气及肠外积气有较高的诊断特异度(85.9%,98.4%和100%),阑尾周围炎、局限性肠壁强化减弱及阑尾动脉不显示诊断敏感度较高(100%,73.1%和80.8%)。以局限性强化减弱、肠壁积气及肠外积气为诊断标准,坏疽阑尾的影像诊断准确度有提高,敏感度为92.3%,特异度为85.9%。结论坏疽阑尾影像表现复杂且具特征性,64层螺旋CT多期增强扫描可以充分显示病变的多种征象,但不能单独作为诊断标准,需结合多种征象判断阑尾坏疽。

Objective To identify the diagnostic value and features of gangrenous appendicitis using 64-slice spiral CT. Methods A total of 90 patients with pathologically and surgically proved appendicitis were enrolled in the retrospeetive clinical trial, 26 cases in gangrene group and 64 cases in un-gangrene group. The multidetector CT images obtained in all patients for various findings were analyzed blindly. The difference and accuracy was analyzed： Results The rate of gangrenous appendicitis in our study was 28. 9%, peritonitis, focal wall enhancement defect,extraluminal gas and intestinal wall gas were useful in gangrene group （P〈0.05）. CT findings of enhancement defect in the appendiceal wall （85.9%）, intestinal wall gas （98.4%） ,and extraluminal gas （100%） had the high specificity and peritonitis（lO0%） ,enhancement defect（73.1%）and display blur of appendicular artery（80.8%） had high sensitivity. We see excellent sensitivity （92.3%）and specificity （85.9%） for the diagnosis of gangrenous appendicitis when evaluated in a group of patients with focal wall enhancement defect,extraluminal gas and intestinal wall gas. Conclusion CT findings of gangrenous appendicitis were complex and Specific, 64-slice spiral CT was an extremely useful method for evaluation the pathological ehanges,but it was unadvisable for using the CT finding alone.