Daly Caroline P, Cohan Richard H, Francis Isaac R, Caoili Elaine M, Ellis James H, Nan Bin
Department of Radiology, Rm. B1D502G, University of Michigan Medical Center, 1500 E Medical Center Dr., Ann Arbor, MI 48109-0030, USA.
AJR Am J Roentgenol. 2005 Jun;184(6):1813-20. doi: 10.2214/ajr.184.6.01841813.
The purpose of our study was to determine the incidence of acute appendicitis in patients for whom the CT interpretation is deemed equivocal.
Of 1,344 patients referred for CT with suspected appendicitis between January 1998 and December 2002, 172 patients were identified in whom the radiographic findings were equivocal. Two radiologists reviewed the equivocal CT cases, reassessing appendiceal size and the presence of right lower quadrant stranding, fluid, or an appendicolith. The reviewers' findings were correlated with surgical pathology reports and clinical follow-up.
Fifty-three (31%) of 172 patients with indeterminate findings on CT scans were subsequently diagnosed with appendicitis. For reviewers 1 and 2, respectively, appendicitis was present in five (14%) of 36 and six (13%) of 47 patients who had isolated appendiceal diameter less than 9 mm, and in 11 (52%) of 21 and in 10 (50%) of 20 patients who had isolated appendiceal dilatation equal to or greater than 9 mm. If a normal diameter appendix (< 6 mm) was visualized in a patient who had right lower quadrant stranding or fluid, appendicitis was present in only one (17%) of six and in four (27%) of 15 patients for reviewers 1 and 2, respectively. If the appendix could not be identified but there was right lower quadrant stranding or fluid, appendicitis was present in seven (37%) of 19 and in eight (53%) of 15 patients.
Appendicitis is encountered in about 30% of patients with equivocal findings on CT, and the diagnosis should be considered in most of these patients if they are appropriately symptomatic. However, when the appendix measures less than 9 mm alone, the likelihood of appendicitis is much smaller.
我们研究的目的是确定CT影像诊断不明确的患者中急性阑尾炎的发病率。
在1998年1月至2002年12月期间，1344例因疑似阑尾炎而接受CT检查的患者中，有172例患者的影像学检查结果不明确。两名放射科医生对这些不明确的CT病例进行了复查，重新评估阑尾大小以及右下腹是否存在条索状影、积液或阑尾粪石。将复查结果与手术病理报告及临床随访情况进行对比。
172例CT扫描结果不确定的患者中，有53例（31%）随后被诊断为阑尾炎。对于第1位和第2位复查医生，在阑尾直径单独小于9mm的36例患者中，分别有5例（14%）和6例（13%）患有阑尾炎；在阑尾直径单独等于或大于9mm的21例患者中，分别有11例（52%）和10例（50%）患有阑尾炎。如果在右下腹存在条索状影或积液的患者中看到阑尾直径正常（<6mm），对于第1位和第2位复查医生，在6例患者中分别只有1例（17%）和15例患者中的4例（27%）患有阑尾炎。如果未发现阑尾但右下腹存在条索状影或积液，在19例患者中有7例（37%），在15例患者中有8例（53%）患有阑尾炎。
CT影像诊断不明确的患者中约30%患有阑尾炎，如果这些患者有相应症状，大多数情况下应考虑阑尾炎的诊断。然而，当阑尾单独测量小于9mm时，患阑尾炎的可能性要小得多。
