CT在儿童急性阑尾炎评估中对超声和PAS评分系统的补充价值

Additional balue of CT to ultrasound and PAS scoring system for assessing children acute appendicitis

目的对比分析儿童阑尾炎评分(pediatric appendicitis score,PAS)系统、超声和CT对儿童急性阑尾炎的诊断效能,探讨CT检查对超声有无补充诊断价值。方法回顾性收集并分析2018年1月至2022年12月河南中医药大学第一附属医院临床疑诊阑尾炎并行超声及CT检查的患儿274例。以手术病理或随访结果为标准,分为急性阑尾炎组和非急性阑尾炎组,急性阑尾炎分为单纯性阑尾炎和复杂性阑尾炎。根据临床资料对每位患儿进行PAS评分(低、中、高危)。分析对比PAS评分系统、超声和CT对儿童急性阑尾炎的诊断效能、超声和CT对阑尾粪石和对复杂性阑尾炎的检出率。对超声检查阴性者,计算联合补充CT检查的诊断效能。超声和CT对复杂性阑尾炎分型一致性采用Kappa检验。结果196名患儿经手术确诊为急性阑尾炎,包括单纯性23例和复杂性173例;78例为非急性阑尾炎。PAS评分高危、中高危对急性阑尾炎诊断的敏感度分别为44.9%、86.7%,特异度分别为96.2%、35.9%。超声和CT诊断敏感度分别为87.8%、95.9%,特异度分别为92.3%、93.5%,阳性似然比分别为11.4、14.9。在超声检查阴性者中,联合补充CT可检出70.8%(17/24)的漏诊患者;超声联合补充CT诊断敏感度为96.4%,阴性似然比为0.04。CT对阑尾粪石(83.9%vs 61.6%)和复杂性阑尾炎(84.4%vs 71.1%)检出率均高于超声(P<0.05)。CT和超声对复杂性阑尾炎分型与手术结果一致性Kappa值分别为0.756和0.584;其中CT对坏疽并穿孔的检出率(92.3%)高于超声(69.2%)(P=0.010)。结论在儿童急性阑尾炎的诊断中,PAS评分系统不能替代影像学检查;CT对超声检查阴性者、粪石检出和复杂性阑尾炎有补充诊断价值。

Objective To analyze and compare the diagnosis value of pediatric appendicitis score(PAS)scoring system,ultrasound and CT for children acute appendicitis and to explore the additional value of supplement CT to ultrasound.Methods The data of 274 suspected acute appendicitis children which both had ultrasound and CT were retrospectively collected.The patients were divided into acute appendicitis and non-appendicitis groups according to pathological and follow-up results,and appendicitis were divided into simple and complicated appendicitis.PAS scoring system was used to categorize patients into low,medium,or high risk groups.The diagnostic efficiency of PAS scoring system,ultrasound and CT for acute appendicitis,the detection rate of ultrasound and CT for appendiceal fecalith and complicated appendicitis were analysed respectively.For the negative ultrasound children,the diagnostic efficiency of ultrasound combined with supplement CT was analysed.The consistency of ultrasound and CT for complicated appendicitis typing with pathological result were accessed by using Kappa test.Results Totally 196 cases acute appendicitis were confirmed by pathology,including 23 cases simple and 173 cases complicated appendicitis,and the remaining 78 cases were non-appendicitis.The sensitivity of high risk and medium-high risk PAS scoring were 44.9%and 86.7%,and the specificity were 96.2%and 35.9%.The sensitivity,specificity and positive likelihood ratio of ultrasound and CT were 87.8%and 95.9%,92.3%and 93.5%,11.4 and 14.9,respectively.Supplement CT detected 70.8%(17/24)ultrasound missed cases,the sensitivity and negative likelihood ratio of ultrasound combined with and supplement CT were 96.4%and 0.04.The CT detection rate for appendiceal fecalith(83.9%vs 61.6%)and complicated appendicitis(84.4%vs 71.1%)both were higher than those of ultrasound(P<0.05).The Kappa value of CT and ultrasound for complicated appendicitis typing were 0.756 and 0.584.The CT detection rate for gangrenous perforated appendicitis(92.3%vs 69.2%)was higher than that of ultrasound(P=0.010).Conclusion PAS scoring system can not replace imaging examinations in diagnosing children acute appendicitis;supplement CT has additional value for negative ultrasound condition,appendiceal fecalith and complicated appendicitis detection.