多层螺旋CT各向同性冠状位重组图像在成人不典型急性阑尾炎诊断及分型中的应用价值

Application Value of Multi-slice Spiral CT Isotropic Coronal Reconstruction Image in the Diagnosis and Classification of Atypical Acute Appendicitis in Adults

目的:探讨多层螺旋CT各向同性冠状位重组图像在成人不典型急性阑尾炎诊断及分型中的应用价值。方法:回顾性分析2017年1月至2019年12月间本院收治的75例疑似不典型急性阑尾炎患者的临床资料,所有患者均给予64层螺旋CT平扫与增强扫描,由3位资历不同的放射科医生独立观察CT成像的横断位图像以及横断位+冠状位图像。探讨多层螺旋CT在不典型急性阑尾炎诊断和分型中的应用价值。结果:工作资历5年者、10年者和15年者在横断位+冠状位扫描对不典型急性阑尾炎方面的诊断灵敏性和特异性虽均略高于横断位扫描结果,但两者对比均不具有统计学意义(P>0.05)。36例确诊患者在参考CT分型和手术病理结果的情况下最终诊断为阑尾结构完整可辨型15例、阑尾结构难辨型10例、阑尾结构不清型7例和团块型4例。从横断位图像读片发现,其与病理检查结果在不典型急性阑尾炎分型的Kappa值为0.3775,一致性较差;从横断位+冠状位图像读片发现,其与病理检查结果在不典型急性阑尾炎分型的Kappa值为0.7234,一致性良好。结论:无论是多层螺旋CT横断位还是横断位+冠状位对成人不典型急性阑尾的诊断均具有较高的应用价值,但在判断患者疾病分型方面横断位+冠状位的读片结果更能获得与手术病理结果高度一致的答案,临床应用价值更高。

Objective:To evaluate the value of isotropic coronal reconstruction of multi-slice spiral CT in the diagnosis and classification of atypical acute appendicitis in adults.Methods:the clinical data of 75 patients with suspected atypical acute appendicitis treated in our hospital from January 2017 to December 2019 were retrospectively analyzed.All patients were given 64 slice spiral CT plain scan and enhanced scan.Three radiologists with different qualifications independently observed the transverse and transverse+coronal images of CT imaging.To explore the value of multi-slice spiral CT in the diagnosis and classification of atypical acute appendicitis.Results:the sensitivity and specificity of transverse and coronal scanning in the diagnosis of atypical acute appendicitis were slightly higher than those of transverse scanning,but the comparison between them was not statistically significant(P>0.05).With reference to CT classification and surgical pathological results,36 patients were finally diagnosed as complete and recognizable appendix structure in 15 cases,difficult appendix structure in 10 cases,unclear appendix structure in 7 cases and mass type in 4 cases.The kappa value of atypical acute appendicitis was 0.3775,which was less consistent with the pathological results;The kappa value of atypical acute appendicitis was 0.7234,which was in good agreement with the pathological results.Conclusion:the diagnosis of atypical acute appendicitis in adults,whether from the transverse section or transverse section+coronal section of multi-slice spiral CT,has high application value.However,in judging the disease classification of patients,the reading results of transverse section+coronal section can obtain a highly consistent answer with the surgical and pathological results,and the clinical application value is higher.