穿孔性与非穿孔性阑尾炎：阑尾壁强化缺损——多层螺旋CT表现

Perforated and nonperforated appendicitis: defect in enhancing appendiceal wall--depiction with multi-detector row CT.

作者信息

Tsuboi Masahiro, Takase Kei, Kaneda Iwao, Ishibashi Tadashi, Yamada Takayuki, Kitami Masahiro, Higano Shuichi, Takahashi Shoki

机构信息

Department of Radiology, Ishinomaki Red Cross Hospital, 1-7-10 Yoshino, Ishinomaki, Miyagi 986-8522, Japan.

出版信息

Radiology. 2008 Jan;246(1):142-7. doi: 10.1148/radiol.2461051760.

DOI:10.1148/radiol.2461051760

PMID:18096535

Abstract

PURPOSE

To retrospectively evaluate the accuracy of multi-detector row helical computed tomography (CT) with intravenous contrast material and without oral contrast material for depiction of perforated appendicitis.

MATERIALS AND METHODS

This study was approved by the institutional review board; informed consent was waived. CT images in 102 patients (60 male patients, 42 female patients; age range, 4-82 years; mean age, 37.3 years) with surgically and pathologically proved appendicitis who were examined between January 2000 and December 2002 were retrospectively reviewed. Original transverse sections at 3- or 2-mm collimation and 1.5- or 1.0-mm intervals were viewed by using cine mode observation. Two independent observers evaluated five specific findings (defect in enhancing appendiceal wall, abscess, phlegmon, extraluminal air, and extraluminal appendicolith). Sensitivity, specificity, and accuracy of the specific findings in the diagnosis of perforated appendicitis were evaluated.

RESULTS

Perforated appendicitis was present in 40 patients, and nonperforated appendicitis was present in 62 patients. A defect in the enhancing appendiceal wall was present in 38 patients in the perforated group. Two patients in the nonperforated group had false-positive findings for a defect in the enhancing appendiceal wall. Sensitivity, specificity, and accuracy of this finding in the diagnosis of perforation were 95.0%, 96.8%, and 96.1%, respectively. Sensitivities for abscess, extraluminal air, and extraluminal appendicolith were 37.5%, 22.5%, and 32.5%, respectively. These three findings were not found in patients with nonperforated appendicitis. Phlegmon was seen in 16 patients in the perforated group and in three patients in the nonperforated group. Sensitivity, specificity, and accuracy of phlegmon in the diagnosis of perforation were 40.0%, 95.2%, and 73.5%, respectively.

CONCLUSION

Multi-detector row CT allows an accurate (96.1%) diagnosis of appendiceal perforation by the depiction of a defect in the contrast material-enhanced appendiceal wall.

摘要

目的

回顾性评估多层螺旋计算机断层扫描（CT）在静脉注射对比剂且未口服对比剂情况下对穿孔性阑尾炎的诊断准确性。

材料与方法

本研究经机构审查委员会批准；无需知情同意。回顾性分析2000年1月至2002年12月期间102例经手术及病理证实为阑尾炎患者（60例男性，42例女性；年龄范围4 - 82岁；平均年龄37.3岁）的CT图像。采用电影模式观察原始3或2毫米准直、1.5或1.0毫米间隔的横断面图像。两名独立观察者评估五个特定表现（强化阑尾壁缺损、脓肿、蜂窝织炎、腔外气体和腔外阑尾结石）。评估这些特定表现在诊断穿孔性阑尾炎中的敏感性、特异性和准确性。

结果

40例患者为穿孔性阑尾炎，62例患者为非穿孔性阑尾炎。穿孔组38例患者存在强化阑尾壁缺损。非穿孔组2例患者强化阑尾壁缺损出现假阳性结果。该表现在诊断穿孔中的敏感性、特异性和准确性分别为95.0%、96.8%和96.1%。脓肿、腔外气体和腔外阑尾结石的敏感性分别为37.5%、22.5%和32.5%。非穿孔性阑尾炎患者未发现这三种表现。穿孔组16例患者及非穿孔组3例患者可见蜂窝织炎。蜂窝织炎在诊断穿孔中的敏感性、特异性和准确性分别为40.0%、95.2%和73.5%。