1 Department of Radiology, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
AJR Am J Roentgenol. 2017 Oct;209(4):762-766. doi: 10.2214/AJR.16.17715. Epub 2017 Aug 4.
The objective of our study was to assess the utility of CT features in the diagnosis of cecal volvulus.
Forty-three patients undergoing CT for cecal volvulus and with surgical or clinical follow-up were included. Two radiologists (11 years and 1 year of experience) evaluated CT examinations for the following: whirl sign, abnormal cecal position, "bird beak" sign, severe cecal distention, mesenteric engorgement, a newly described "central appendix" sign (defined as abnormal appendix position near midline), and overall impression for cecal volvulus. Univariable and multivariable assessments were performed. Patients with CT examinations in which the appendix was not visible were excluded from calculations involving the central appendix sign.
Fifty-one percent (n = 22) of patients had cecal volvulus. All CT findings were significantly more common in patients with cecal volvulus (p < 0.01) other than mesenteric engorgement for reader 1 (p = 0.332). Readers 1 and 2 identified the central appendix sign in 92.9% and 92.3% of patients with volvulus versus in 37.5 and 31.1% of patients without volvulus. The whirl sign exhibited a sensitivity for cecal volvulus of 90.9% for reader 1 and 95.5% for reader 2, and a specificity of 61.9% for both readers. Abnormal cecal position exhibited a sensitivity of 90.0% for reader 1 and 100.0% for reader 2 and a specificity of 66.7% and 38.1%. The bird beak sign exhibited a sensitivity of 86.4% for reader 1 and 100.0% for reader 2 and a specificity of 85.7% and 71.4%. Severe cecal distention exhibited a sensitivity of 100.0% for both readers and a specificity of 81.0% and 61.9%. Mesenteric engorgement exhibited a sensitivity of 40.9% for reader 1 and 100.0% for reader 2 and a specificity of 76.2% and 71.4%. The central appendix sign exhibited a sensitivity of 92.9% for reader 1 and 92.3% for reader 2 and a specificity of 62.5% and 68.8%. Overall impression exhibited a sensitivity of 100.0% for both readers and a specificity of 76.2% and 57.1%. At multivariable analysis, the AUC for cecal volvulus ranged from 0.787 to 0.931, and the whirl sign was an independent predictor of volvulus for both readers (p ≤ 0.014); the central appendix sign was also an independent predictor in patients with a visualized appendix for reader 2 (p ≤ 0.001).
CT exhibited high diagnostic performance and very high sensitivity for cecal volvulus. The whirl sign was a significant independent predictor of volvulus for both readers.
我们的研究目的是评估 CT 特征在盲肠扭转诊断中的应用价值。
共纳入 43 例经 CT 检查诊断为盲肠扭转并接受手术或临床随访的患者。两位放射科医生（分别具有 11 年和 1 年的经验）评估了 CT 检查中的以下特征：漩涡征、盲肠位置异常、“鸟嘴”征、严重盲肠扩张、肠系膜充血、新描述的“中央阑尾”征（定义为阑尾中线附近的异常位置）以及盲肠扭转的整体印象。进行了单变量和多变量评估。由于阑尾在 CT 检查中不可见，因此排除了与中央阑尾征相关的计算。
51%（n=22）的患者存在盲肠扭转。除了肠系膜充血外（读者 1，p=0.332），所有 CT 发现均在盲肠扭转患者中更常见（p＜0.01）。读者 1 和 2 在 92.9%和 92.3%的扭转患者中识别出中央阑尾征，而在无扭转的患者中分别为 37.5%和 31.1%。漩涡征对盲肠扭转的敏感性为读者 1 的 90.9%和读者 2 的 95.5%，特异性为两位读者的 61.9%。盲肠位置异常的敏感性为读者 1 的 90.0%和读者 2 的 100.0%，特异性为 66.7%和 38.1%。鸟嘴征的敏感性为读者 1 的 86.4%和读者 2 的 100.0%，特异性为 85.7%和 71.4%。严重盲肠扩张的敏感性为两位读者的 100.0%，特异性为 81.0%和 61.9%。肠系膜充血的敏感性为读者 1 的 40.9%和读者 2 的 100.0%，特异性为 76.2%和 71.4%。中央阑尾征的敏感性为读者 1 的 92.9%和读者 2 的 92.3%，特异性为 62.5%和 68.8%。整体印象的敏感性为两位读者的 100.0%，特异性为 76.2%和 57.1%。多变量分析显示，盲肠扭转的 AUC 范围为 0.787 至 0.931，漩涡征是两位读者预测扭转的独立预测因子（p≤0.014）；对于可见阑尾的患者，中央阑尾征也是读者 2 预测扭转的独立预测因子（p≤0.001）。
CT 对盲肠扭转具有较高的诊断性能和很高的敏感性。漩涡征是两位读者预测扭转的重要独立预测因子。
