Cabarrus Miguel, Sun Yee-Li, Courtier Jesse L, Stengel Joseph W, Coakley Fergus V, Webb Emily M
Department of Radiology and Biomedical Imaging, University of California San Francisco, Box 0628, M-372, 505 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
Emerg Radiol. 2013 Jan;20(1):51-6. doi: 10.1007/s10140-012-1076-6. Epub 2012 Sep 21.
The purpose of this study is to investigate if the presence and distribution of intraluminal air in the appendix contributes to the computed tomography (CT) diagnosis of appendicitis. We identified 100 consecutive patients (57 men and 43 women; mean age, 38) with CT prior to appendectomy for acute appendicitis over a 5-year period and a control group of 100 consecutive patients (29 men and 71 women; mean age, 39) who underwent CT for acute abdominal pain without appendicitis. Patients were scanned using multidetector row CT scanners at 1.25 or 5-mm slice thickness, peak tube voltage of 120 kVp, and milliamperse automatically adjusted to attain a noise index of 12. Ninety-two of 100 study patients and 95 of 100 controls received 150 mL intravenous contrast. Two independent readers noted the presence and distribution pattern of intraluminal air in the appendix, appendiceal diameter, wall hyperemia, wall thickening (>3 mm), and wall stratification and presence of any secondary signs of appendicitis including fat stranding and free fluid. Data were compared between groups using Fisher's exact test and Student's t test. Intraluminal air in the appendix was more common in control patients versus patients with appendicitis (66 of 100 versus 27 of 100, p < 0.001). No significant differences in the patterns of intraluminal air were found between cases and controls. Among appendicitis cases, there was no significant difference in mean appendiceal diameter (12.8 versus 12.0, p = 0.20) or number of CT signs of appendicitis (1.93 versus 1.86, p = 0.78) in cases with intraluminal air versus without. No case of appendicitis demonstrated intraluminal air without secondary signs of appendicitis. Although intraluminal air is sometimes assumed to exclude a diagnosis of appendicitis, it is actually a common finding seen in up to 27 % of cases at CT. The pattern of intraluminal air was not helpful in differentiating a normal appendix from appendicitis.
本研究的目的是调查阑尾腔内气体的存在和分布是否有助于计算机断层扫描（CT）对阑尾炎的诊断。我们纳入了在5年期间因急性阑尾炎行阑尾切除术前行CT检查的100例连续患者（57例男性和43例女性；平均年龄38岁），以及100例因急性腹痛行CT检查但无阑尾炎的连续患者作为对照组（29例男性和71例女性；平均年龄39岁）。患者使用多层螺旋CT扫描仪进行扫描，层厚为1.25或5毫米，管电压峰值为120 kVp，毫安自动调整以达到噪声指数12。100例研究患者中有92例和100例对照组中有95例接受了150毫升静脉造影剂。两名独立阅片者记录阑尾腔内气体的存在和分布模式、阑尾直径、壁充血、壁增厚（>3毫米）、壁分层以及阑尾炎的任何继发性征象，包括脂肪条纹和游离液体。使用Fisher精确检验和Student t检验对组间数据进行比较。对照组患者阑尾腔内气体比阑尾炎患者更常见（100例中的66例对100例中的27例，p<0.001）。病例组和对照组之间在腔内气体模式上未发现显著差异。在阑尾炎病例中，有腔内气体与无腔内气体的病例在平均阑尾直径（12.8对12.0，p = 0.20）或阑尾炎CT征象数量（1.93对1.86，p = 0.78）方面无显著差异。没有阑尾炎病例显示腔内气体而无阑尾炎的继发性征象。尽管有时认为腔内气体可排除阑尾炎诊断，但实际上在CT检查中高达27%的病例中是常见发现。腔内气体模式无助于区分正常阑尾和阑尾炎。
