Patriquin H B, Garcier J M, Lafortune M, Yazbeck S, Russo P, Jequier S, Ouimet A, Filiatrault D
Department of Radiology, Hopital Sainte-Justine, Montreal, Quebec, Canada.
AJR Am J Roentgenol. 1996 Mar;166(3):629-33. doi: 10.2214/ajr.166.3.8623640.
The purpose of this study was to determine the following: whether the arterial supply of a normal appendix is visible with Doppler sonography; whether the physiologic vasodilatation that accompanies childhood appendicitis is visible; what Doppler patterns appear once necrosis of the appendix has occurred; what Doppler shifts are visible with chronic, recurrent appendicitis; and whether other conditions in the right lower quadrant can mimic the Doppler sonographic patterns of appendicitis.
Twenty-five fasting patients without abdominal pain or intestinal disease and 45 patients (1-25 years old; mean, 8 years old) with right lower quadrant pain and suspected appendicitis were examined sonographically, using 5- and 7-MHz linear, color, and pulsed Doppler transducers. Arterial signals were sought within the appendix and neighboring tissues, counted, and classified as sparse (1-2), moderate (3-4), or abundant (>4). The resistive index (RI) was measured. Thirty patients who underwent surgery were retained for surgical and pathologic correlation, and only they formed the appendicitis study.
A normal appendix was found in 10 patients. Doppler shifts were sparse, and diastolic flow was low or absent (RI, 0.85-1). Acute uncomplicated appendicitis was found in 13 patients, who had abundant color Doppler signals throughout most of the appendix, with high diastolic flow (RI, 0.40-0.77; mean, 0.54). Acute necrotic appendicitis with perforation was found in 11 children, eight of whom showed no signals in the necrotic area at the tip. Few or no signals were seen in the remainder of the appendix (RI, 0.33-0.90; mean, 0.54). In two patients, signals were abundant in the tissues surrounding the appendix. Recurrent or chronic appendicitis was found in three patients, previously diagnosed as having Crohn's disease, psychosomatic illness, or nonspecific abdominal pain. The appendix had Doppler signals confined to the tip (RI, 0.63-0.83; mean, 0.75). Other diagnoses were found in three patients, in whom the appendix was not seen. There were abundant color signals in the intestinal wall and adjacent tissues in the right lower quadrant. Two patients had Crohn's disease, and the third had an unsuspected early pregnancy. The appendix was normal in all.
Acute appendicitis is accompanied by inflammatory hypervascularity reflected as an increased number of color signals and higher diastolic Doppler shifts as compared with those found in normal persons. No Doppler shifts are identified in areas of appendiceal ischemia. Other acute inflammation in the right lower quadrant also produces numerous Doppler shifts with high diastolic flow, as does ovulation. Care must be taken to identify the source of these Doppler signals. The changing vascularity of healing, recurrent, and chronic appendicitis promises to further our understanding of the pathogenesis and evolution of this disease.
本研究的目的是确定以下内容：正常阑尾的动脉供应能否用多普勒超声显示；儿童阑尾炎伴随的生理性血管扩张能否被观察到；阑尾发生坏疽后会出现何种多普勒模式；慢性复发性阑尾炎能观察到何种多普勒频移；以及右下腹的其他病症是否会模仿阑尾炎的多普勒超声模式。
对25例无腹痛或肠道疾病的空腹患者以及45例（年龄1至25岁，平均8岁）有右下腹疼痛且疑似阑尾炎的患者进行超声检查，使用5兆赫和7兆赫的线性、彩色及脉冲多普勒换能器。在阑尾及邻近组织内寻找动脉信号，计数并分类为稀疏（1至2个）、中等（3至4个）或丰富（>4个）。测量阻力指数（RI）。30例接受手术的患者被保留用于手术与病理对照，只有他们构成了阑尾炎研究对象。
10例患者阑尾正常。多普勒频移稀疏，舒张期血流低或无（RI，0.85至1）。13例患者为急性单纯性阑尾炎，其阑尾大部分区域有丰富的彩色多普勒信号，舒张期血流高（RI，0.40至0.77；平均0.54）。11例儿童为急性坏死性阑尾炎伴穿孔，其中8例在阑尾尖端坏死区域无信号。阑尾其余部分信号很少或无信号（RI，0.33至0.90；平均0.54）。2例患者阑尾周围组织信号丰富。3例患者为复发性或慢性阑尾炎，之前诊断为克罗恩病、心身疾病或非特异性腹痛。阑尾的多普勒信号局限于尖端（RI，0.63至0.83；平均0.75）。3例患者有其他诊断结果，未发现阑尾。右下腹肠壁及邻近组织有丰富的彩色信号。2例患者患有克罗恩病，第3例患者意外怀孕早期。所有患者阑尾均正常。
急性阑尾炎伴有炎症性血管增多，表现为与正常人相比彩色信号数量增加以及舒张期多普勒频移更高。阑尾缺血区域未发现多普勒频移。右下腹的其他急性炎症以及排卵也会产生大量舒张期血流高的多普勒频移。必须注意识别这些多普勒信号的来源。愈合期、复发性和慢性阑尾炎血管的变化有望进一步加深我们对该疾病发病机制和演变的理解。
