大小很重要：急诊科扫描中阑尾的计算机断层扫描测量。

Size matters: Computed tomographic measurements of the appendix in emergency department scans.

机构信息

Department of Trauma and Acute Care Surgery, UCHealth- Memorial Hospital, Colorado Springs, CO, USA; Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.

Department of Trauma and Acute Care Surgery, UCHealth- Memorial Hospital, Colorado Springs, CO, USA.

出版信息

Am J Surg. 2019 Aug;218(2):271-274. doi: 10.1016/j.amjsurg.2018.12.010. Epub 2018 Dec 11.

DOI:10.1016/j.amjsurg.2018.12.010

PMID:30558802

Abstract

BACKGROUND

Radiologists use a size cutoff in appendiceal diameter to assist surgeons in diagnosing appendicitis, however, no consensus exists as to the size of a normal adult appendix. We aim to evaluate radial appendiceal diameter on CT in adult patients both with and without appendicitis.

METHODS

Retrospective review of adults who underwent abdominal CT was performed. Variables collected include: demographics, BMI, WBC count at presentation, radial diameter of appendix (mm), presence of fat stranding, fecalith, and free fluid.

RESULTS

During the study period, 3099 patients underwent CT. The appendix was visualized on 74% of scans. Mean appendiceal diameter was 6.6 mm (±1.7). The appendix was larger in patients with appendicitis (6.6 vs. 11.4; p < 0.0001). Overall appendectomy incidence was 3.2%. Sensitivity and specificity of CT in diagnosing appendicitis in this cohort of patients were 90% and 94%. NPV was 99.5%.

CONCLUSION

While appendiceal diameter was larger in patients with appendicitis, >20% of patients without appendicitis had an appendiceal diameter >7 mm. Diameter alone should not be relied upon to diagnose appendicitis.

摘要

背景

放射科医生使用阑尾直径的大小截断值来协助外科医生诊断阑尾炎，然而，对于正常成人阑尾的大小尚无共识。我们旨在评估 CT 上成人阑尾炎和非阑尾炎患者的阑尾径向直径。

方法

对接受腹部 CT 检查的成年人进行回顾性研究。收集的变量包括：人口统计学、BMI、就诊时的白细胞计数、阑尾的径向直径（mm）、有无脂肪条纹、粪石和游离液体。

结果

在研究期间，有 3099 名患者接受了 CT 检查。74%的扫描可见阑尾。阑尾平均直径为 6.6±1.7mm。阑尾炎患者的阑尾直径较大（6.6 与 11.4；p<0.0001）。总的阑尾切除术发生率为 3.2%。在该患者队列中，CT 诊断阑尾炎的敏感性和特异性分别为 90%和 94%。NPV 为 99.5%。