Khandwala Kumail, Sajjad Nida, Khan Dawar Burhan, Malik Amyn A, Memon Wasim Ahmed, Rao Muhammad Owais, Ud Din Nasir, Khan Faheemullah, Ahmed Khabab Abbasher Hussien Mohamed
Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan.
Department of Medicine, O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA.
BMC Gastroenterol. 2025 Jan 28;25(1):40. doi: 10.1186/s12876-025-03630-7.
BACKGROUND & OBJECTIVES: Differentiation of histologic subtypes of appendiceal mucoceles may prove to be difficult on computed tomography (CT). The main objective of this study was to identify the CT features of mucocele of the appendix and correlate the imaging findings with histopathology in inflammatory, benign, and malignant neoplastic lesions, and whether these entities can be accurately differentiated on CT imaging.
CT scans of 31 patients with diagnosis of appendiceal mucocele were retrospectively reviewed and compared with histopathology. The appendix was evaluated for maximal luminal diameter, cystic dilatation, luminal attenuation, appendicolith, mural calcification and enhancement, periappendiceal fat stranding and fluid. CT findings were compared by use of Mann-Whitney U and Fisher's exact tests. Receiver operating characteristics analysis was performed to assess the diagnostic utility of appendiceal luminal diameter in differentiating different types of mucoceles.
Patients were classified into three groups: those with inflammatory mucoceles (n = 10), benign mucoceles (simple mucocele, mucosal hyperplasia and low-grade appendiceal mucinous neoplasm (n = 17), and those with malignant mucinous adenocarcinoma (n = 4). The mean diameter was found to be significantly different in the three groups with the largest diameter in the benign subgroup. Soft tissue thickening (p-value 0.01), mural calcification (p-value < 0.01), internal septation (p-value 0.02) and fat stranding (p-value 0.05) was found to be of statistical significance among the various groups. The best cut-off diameter for diagnosis of inflammatory mucoceles to be ≤ 2.3 cm with a sensitivity of 71% and specificity of 90%.
Our study suggests that CT findings such as appendiceal diameter less than 2.3 cm, absence of soft tissue thickening, mural calcification and internal septation may be useful in preoperative diagnosis of inflammatory appendiceal mucocele.
在计算机断层扫描（CT）上，阑尾黏液囊肿的组织学亚型鉴别可能存在困难。本研究的主要目的是确定阑尾黏液囊肿的CT特征，并将影像表现与炎症性、良性和恶性肿瘤性病变的组织病理学进行关联，以及这些实体在CT影像上是否能够被准确区分。
回顾性分析31例诊断为阑尾黏液囊肿患者的CT扫描结果，并与组织病理学结果进行比较。评估阑尾的最大管腔直径、囊性扩张、管腔密度、阑尾结石、壁钙化及强化、阑尾周围脂肪条索和积液情况。采用Mann-Whitney U检验和Fisher精确检验比较CT表现。进行受试者操作特征分析，以评估阑尾管腔直径在鉴别不同类型黏液囊肿中的诊断效用。
患者分为三组：炎症性黏液囊肿患者（n = 10）、良性黏液囊肿（单纯黏液囊肿、黏膜增生和低度阑尾黏液性肿瘤，n = 17）以及恶性黏液腺癌患者（n = 4）。发现三组的平均直径存在显著差异，良性亚组的直径最大。软组织增厚（p值0.01）、壁钙化（p值<0.01）、内部间隔（p值0.02）和脂肪条索（p值0.05）在各亚组间具有统计学意义。诊断炎症性黏液囊肿的最佳截断直径为≤2.3 cm，灵敏度为71%，特异度为90%。
我们的研究表明，阑尾直径小于2.3 cm、无软组织增厚、壁钙化和内部间隔等CT表现可能有助于炎症性阑尾黏液囊肿的术前诊断。
