Paulson Erik K, Harris John P, Jaffe Tracy A, Haugan Paul A, Nelson Rendon C
Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710, USA.
Radiology. 2005 Jun;235(3):879-85. doi: 10.1148/radiol.2353041231. Epub 2005 Apr 15.
To assess retrospectively the added value of coronal reformations from isotropic voxels obtained with 16-section multi-detector row computed tomography (CT) of the abdomen and pelvis in patients with suspected acute appendicitis.
This study was approved by the institutional review board, and informed consent was waived. One hundred consecutive patients (21 men, 79 women; mean age, 38 years) with suspected appendicitis underwent 16-section multi-detector row CT (section thickness, 0.625 mm; pitch, 1.75; table speed, 35 mm/sec [17.5 mm per rotation, two rotations]; and gantry speed, 0.5 second per rotation), with coronal reformations. Twenty-four patients had appendicitis; 76 did not. Protocol included 150 mL oral iopamidol administered at 3 mL/sec. Transverse scans were reconstructed with 5-mm-thick sections at 5-mm intervals and 0.625-mm-thick sections at 0.625-mm intervals. The second data set was reformatted coronally, with 3-mm-thick sections at 5-mm intervals. Three independent blinded readers interpreted transverse scans alone and then coronal scans; confidence in visualization of any portion of appendix, entire appendix, wall thickening, distention, inflammation, fluid, and appendicitis was scored with 1-5 scale. Sensitivity and specificity were determined for each reader and compared by means of signed rank test. Agreement between readers was determined with kappa statistic. Differences in mean confidence ratings for each finding were determined with Wilcoxon signed rank test.
Mean sensitivity and specificity for all three readers together were 96% and 95% for transverse reformations alone and 95% and 94% for combined transverse and coronal reformations (not significant), respectively. Visualization rates for portion or all of appendix were higher for combined transverse and coronal reformations than for transverse reformations alone (higher mean confidence scores: 0.23 higher [P < .009] and 0.51 higher [P < .001], respectively). In patients without appendicitis, transverse and coronal reformations together enhanced confidence in exclusion of wall thickening, distention, and fluid (lower confidence scores: 0.21 lower [P < .001], 0.17 lower [P < .01], 1.00 lower [P < .001], respectively). Combined transverse and coronal reformations enhanced confidence in identification of appendix in mean of 57 patients. Combined transverse and coronal scans helped exclude appendicitis in mean of 38 patients and aided diagnosis of it in 15.
Sixteen-section multi-detector row CT transverse and coronal reformations are equally sensitive and specific for diagnosis of appendicitis. Coronal reformations improve confidence in visualization of appendix (whether diseased or normal) and in diagnosis or exclusion of appendicitis.
回顾性评估在疑似急性阑尾炎患者中，利用腹部和盆腔16排多层螺旋CT获取的各向同性体素进行冠状位重建的附加价值。
本研究经机构审查委员会批准，且无需签署知情同意书。100例连续的疑似阑尾炎患者（21例男性，79例女性；平均年龄38岁）接受了16排多层螺旋CT检查（层厚0.625mm，螺距1.75，床速35mm/秒[每旋转17.5mm，旋转两圈]，机架旋转速度0.5秒/圈），并进行冠状位重建。24例患者患有阑尾炎；76例未患。检查方案包括以3ml/秒的速度口服150ml碘帕醇。横轴位扫描重建为层厚5mm、间隔5mm的图像以及层厚0.625mm、间隔0.625mm的图像。第二组数据集进行冠状位重排，层厚3mm、间隔5mm。三位独立的盲法阅片者先单独解读横轴位扫描图像，然后解读冠状位扫描图像；对阑尾任何部分、整个阑尾、壁增厚、扩张、炎症、积液以及阑尾炎的可视化信心采用1 - 5分制评分。确定每位阅片者的敏感度和特异度，并通过符号秩检验进行比较。阅片者之间的一致性用kappa统计量确定。通过Wilcoxon符号秩检验确定各发现的平均信心评分差异。
三位阅片者共同的平均敏感度和特异度，单独横轴位重建分别为96%和95%，横轴位与冠状位联合重建分别为95%和94%（无显著差异）。横轴位与冠状位联合重建对阑尾部分或全部的可视化率高于单独横轴位重建（平均信心评分分别高0.23[P < 0.009]和高0.51[P < 0.001]）。在无阑尾炎的患者中，横轴位与冠状位联合重建增强了对壁增厚、扩张和积液排除的信心（信心评分分别低0.21[P < 0.001]、低0.17[P < 0.01]、低1.00[P < 0.001]）。横轴位与冠状位联合重建使平均57例患者对阑尾的识别信心增强。横轴位与冠状位联合扫描平均帮助38例患者排除了阑尾炎，并辅助诊断了15例患者的阑尾炎。
16排多层螺旋CT横轴位和冠状位重建对阑尾炎诊断的敏感度和特异度相同。冠状位重建提高了对阑尾（无论病变与否）可视化以及阑尾炎诊断或排除的信心。
