Hashizume Naoki, Iinuma Yasushi, Hirayama Yutaka, Nitta Kohju, Iida Hisataka, Shiotani Motoi, Shibuya Hiroyuki, Yagi Minoru
Department of Pediatric Surgery Niigata City General Hospital Niigata City Fukuoka Japan.
Department of Pediatric Surgery Kurume University School of Medicine Kurume Fukuoka Japan.
Acute Med Surg. 2015 Jun 30;3(1):21-25. doi: 10.1002/ams2.131. eCollection 2016 Jan.
To retrospectively evaluate the correlation between multidetector-row computed tomography findings of acute appendicitis and the pathological status of acute appendicitis, and evaluate the capability of multidetector-row computed tomography to predict the pathological status of acute appendicitis in children.
The presence of a distended appendix (>6 mm in transverse diameter) was used as a primary sign to indicate the presence of appendiceal inflammation. The presence of appendiceal wall thickening (>1 mm) and enhanced appendiceal wall continuity were also used as predictive findings to reflect the degree of progression of acute appendicitis on multidetector-row computed tomography findings. The findings of each individual case were classified into four grades. The final pathological diagnosis was classified into four groups: normal findings, only mucosal inflammation, inflammation with intramural spreading, and gangrenous. The relationship between the pathological grades and computed tomography grades was analyzed using Spearman's rank correlation test.
Four of six cases in Grade 0 reflected normal appendiceal findings (66.7%) and 3 of 5 cases in Grade I reflected only mucosal inflammation status (60.0%). Forty-four of 51 cases in Grade II reflected intramural inflammation status (86.3%), and 40 of 57 cases in Grade III reflected gangrenous status (70.2%). The multidetector-row computed tomography grade was significantly correlated to the pathological grade with Spearman's rank correlation coefficient of 0.689 ( < 0.001).
There was a close relationship between the multidetector-row computed tomography imaging findings and the pathological findings. This preoperative information is extremely useful for decision-making in the treatment strategy for acute appendicitis in children.
回顾性评估多排螺旋计算机断层扫描（MDCT）对急性阑尾炎的诊断结果与急性阑尾炎病理状态之间的相关性，并评估多排螺旋计算机断层扫描预测儿童急性阑尾炎病理状态的能力。
以阑尾增粗（横径>6mm）作为提示阑尾炎症存在的主要征象。阑尾壁增厚（>1mm）及阑尾壁连续性增强也作为预测性表现，以反映多排螺旋计算机断层扫描结果中急性阑尾炎的进展程度。将每个病例的检查结果分为四个等级。最终病理诊断分为四组：正常表现、仅黏膜炎症、炎症伴壁内扩散、坏疽。采用Spearman等级相关检验分析病理分级与计算机断层扫描分级之间的关系。
0级6例中有4例阑尾表现正常（66.7%），Ⅰ级5例中有3例仅表现为黏膜炎症状态（60.0%）。Ⅱ级51例中有44例表现为壁内炎症状态（86.3%），Ⅲ级57例中有40例表现为坏疽状态（70.2%）。多排螺旋计算机断层扫描分级与病理分级显著相关，Spearman等级相关系数为0.689（P<0.001）。
多排螺旋计算机断层扫描成像结果与病理结果密切相关。该术前信息对儿童急性阑尾炎治疗策略的决策极为有用。
