Kim Mi Sung, Park Hae Won, Park Ji Yeon, Park Hee-Jin, Lee So-Yeon, Hong Hyun Pyo, Kwag Hyon Joo, Kwon Heon-Ju
Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung dong, Jongno-gu, Seoul, 110-746, Korea.
Abdom Imaging. 2014 Jun;39(3):459-66. doi: 10.1007/s00261-014-0117-x.
To determine the CT findings and assess their diagnostic performance in differentiating early perforated appendicitis from nonperforated appendicitis, and to compare therapeutic approaches and clinical outcomes between two types of appendicitis. Our retrospective study was approved by our institutional review board and informed consent was waived. From July 2012 to July 2013, 339 patients [mean age 40.8 years; age range 19-80 years; 183 male (mean age 40.5 years; age range 19-79 years) and 156 female (mean age 41.2 years; age range 19-80 years)] who underwent appendectomy with preoperative CT examination for suspected acute appendicitis were included, with exclusion of 37 patients with specific CT findings for advanced perforated appendicitis. And they were categorized into nonperforated and early perforated appendicitis groups according to surgical and pathologic reports. The following CT findings were evaluated by two radiologists blinded to pathologic and surgical findings: transverse diameter of the appendix, thickness of the appendiceal wall, the depth of intraluminal appendiceal fluid, appendiceal wall enhancement, presence or absence of focal defect in the appendiceal wall, intraluminal appendiceal air, appendicolith/fecalith, periappendiceal changes, cecal wall thickening, and free fluid. The type of surgical procedures, performance of surgical drainage, and the length of hospital stay were recorded. Univariate and multivariate logistic regression analysis were used to determine the CT findings for differentiating early perforated appendicitis from nonperforated appendicitis, a total of 75 (22%) of the 339 patients was diagnosed with early perforated appendicitis. Focal wall defect [adjusted odds ratio (aOR), 23.40; p < 0.001], circumferential periappendiceal changes (aOR, 5.63; p < 0.001), appendicoliths/fecaliths (aOR, 2.47; p = 0.015), and transverse diameter of the appendix (aOR, 1.22; p = 0.003) were independently differentiating variables for early perforated appendicitis. The transverse diameter of the appendix (≥11 mm) had the highest sensitivity (62.7%) and focal wall defect in the appendiceal wall showed the highest specificity (98.8%). The prevalence of surgical drainage was higher (p = 0.001) and the mean hospital stay was approximately one day longer (p < 0.001) in the early perforated group than nonperforated group. CT can be helpful in differentiating early perforated appendicitis from nonperforated appendicitis, although the sensitivity of the evaluated findings was somewhat limited.
为确定CT表现并评估其在鉴别早期穿孔性阑尾炎与非穿孔性阑尾炎中的诊断性能，以及比较两种类型阑尾炎的治疗方法和临床结果。我们的回顾性研究获得了机构审查委员会的批准，且无需知情同意。2012年7月至2013年7月，纳入339例因疑似急性阑尾炎接受术前CT检查并行阑尾切除术的患者[平均年龄40.8岁；年龄范围19 - 80岁；男性183例（平均年龄40.5岁；年龄范围19 - 79岁），女性156例（平均年龄41.2岁；年龄范围19 - 80岁）]，排除37例具有晚期穿孔性阑尾炎特定CT表现的患者。根据手术和病理报告将其分为非穿孔性阑尾炎组和早期穿孔性阑尾炎组。由两名对病理和手术结果不知情的放射科医生评估以下CT表现：阑尾横径、阑尾壁厚度、阑尾腔内液体深度、阑尾壁强化、阑尾壁是否存在局灶性缺损、阑尾腔内气体、阑尾结石/粪石、阑尾周围改变、盲肠壁增厚及游离液体。记录手术方式、是否进行手术引流及住院时间。采用单因素和多因素逻辑回归分析确定鉴别早期穿孔性阑尾炎与非穿孔性阑尾炎的CT表现，339例患者中共有75例（22%）被诊断为早期穿孔性阑尾炎。阑尾壁局灶性缺损[校正比值比（aOR），23.40；p < 0.001]、阑尾周围环形改变（aOR，5.63；p < 0.001）、阑尾结石/粪石（aOR，2.47；p = 0.015）及阑尾横径（aOR，1.22；p = 0.003）是早期穿孔性阑尾炎的独立鉴别变量。阑尾横径（≥11 mm）敏感性最高（62.7%），阑尾壁局灶性缺损特异性最高（98.8%）。早期穿孔组手术引流的发生率更高（p = 0.001），平均住院时间比非穿孔组约长1天（p < 0.001）。CT有助于鉴别早期穿孔性阑尾炎与非穿孔性阑尾炎，尽管所评估表现的敏感性有所局限。
