螺旋CT在急性阑尾炎诊断中的价值分析

Value analysis of spinal CT in the diagnosis of acute appendicitis

目的分析螺旋CT在急性阑尾炎(AA)诊断中的临床价值。方法70例疑似AA患者,均予以腹部超声、螺旋CT检查,将手术诊断结果作为金标准,对比腹部超声和螺旋CT诊断准确率、特异度、灵敏度,Kappa检验腹部超声、螺旋CT与金标准的一致性,分析AA螺旋CT征象。结果手术诊断阳性66例、阴性4例。螺旋CT诊断准确率91.43%(64/70)、灵敏度92.42%(61/66)均高于腹部超声的77.14%(54/70)、80.30%(53/66),差异具有统计学意义(χ^(2)=5.393、4.117,P=0.020、0.042<0.05);螺旋CT诊断特异度为75.00%(3/4),与腹部超声的25.00%(1/4)比较,差异无统计学意义(χ^(2)=2.000,P=0.157>0.05)。腹部超声与金标准的一致性一般(Kappa值=0.542),螺旋CT与金标准的一致性较好(Kappa值=0.774)。螺旋CT直接征象:(1)阑尾增粗肿大,直径>6 mm,66例患者阑尾明显增粗,占100.00%,直径在0.65~2.54 cm,平均直径(1.52±0.16)cm;(2)管壁增厚,59例阑尾壁增厚,占89.39%:(3)阑尾腔内积液或积气,39例阑尾腔积液,占59.09%;(4)阑尾粪石:47例阑尾粪石,占72.21%;23例阑尾穿孔,占34.85%;(5)增强扫描之后可见阑尾壁强化,呈轨道征或者环征。34例呈轨道征,占51.52%;43例呈环征,占65.15%。结论螺旋CT可提高AA诊断准确率、特异度、灵敏度,与手术诊断结果接近,同时可提供影像学征象,为治疗方案的制定提供科学的参考依据,避免患者错过最佳的治疗时机,临床价值较高。

Objective To analyze the clinical value of spinal CT in the diagnosis of acute appendicitis(AA).Methods 70 cases of suspected AA patients were examined by abdominal ultrasound and spiral CT.The surgical diagnostic results were used as the gold standard of this study to compare the diagnostic accuracy,specificity and sensitivity of abdominal ultrasound and spiral CT,and Kappa test for the consistency of abdominal ultrasound and spiral CT with the gold standard to analyze the spiral CT signs of AA.Results The surgical diagnosis was positive in 66 cases and negative in 4 cases.The diagnostic accuracy of spiral CT was 91.43%(64/70)and the sensitivity was 92.42%(61/66),which were higher than 77.14%(54/70)and 80.30%(53/66)of abdominal ultrasound,and the differences were statistically significant(χ^(2)=5.393,4.117;P=0.020,0.042<0.05).The diagnostic specificity of spiral CT was 75.00%(3/4),there was no statistically significant compared with 25.00%(1/4)of abdominal ultrasound(χ^(2)=2.000,P=0.157>0.05).The consistency between abdominal ultrasound and the gold standard was general(Kappa value=0.542),and the consistency between spiral CT and the gold standard was good(Kappa value=0.774).Direct signs of spiral CT:①Appendiceal thickening and enlargement,with a diameter of>6 mm.The appendix was significantly thickened in 66 patients,accounting for 100.00%,with a diameter of 0.65-2.54 cm,with an average diameter of(1.52±0.16)cm.②The tube wall was thickened,and the appendix wall was thickened in 59 cases,accounting for 89.39%.③Fluid or gas accumulation in the appendiceal lumen,39 cases of fluid accumulation in the appendiceal lumen,accounting for 59.09%.④Appendiceal fecal stone,47 cases of appendiceal fecal stone,accounting for 72.21%;23 cases of appendiceal perforation,accounting for 34.85%.⑤After the enhancement scan,the appendiceal wall was strengthened with orbital or annular sign.34 cases showed orbital sign,accounting for 51.52%;43 cases showed annular sign,accounting for 65.15%.Conclusion CT can improve the diagnostic accuracy,specificity and sensitivity of AA,which is close to the results of surgical diagnosis.At the same time,CT can provide imaging signs,provide scientific reference for the formulation of treatment plan,and avoid patients from missing the best treatment opportunity.It has high clinical value.