Rao P M, Rhea J T, Novelline R A
Department of Radiology, Massachusetts General Hospital, Boston 02114, USA.
J Comput Assist Tomogr. 1997 Sep-Oct;21(5):686-92. doi: 10.1097/00004728-199709000-00002.
Our goal was to determine the sensitivity, specificity, and diagnostic value of individual signs at helical appendiceal CT.
Two hundred helical appendiceal CT scans (100 appendicitis and 100 normal appendix cases) were interpreted for individual signs of appendicitis. Scan findings were correlated with appendectomy or clinical follow-up results.
Individual CT signs identified and their sensitivity and specificity, respectively, included fat stranding (100%, 80%), enlarged (> 6 mm) unopacified appendix (93%, 100%), focal cecal apical thickening (69%, 100%), adenopathy (62%, 66%), appendolith(s) (44%, 100%), arrowhead sign (23%, 100%), paracolic gutter fluid (18%, 86%), abscess (11%, 100%), cecal bar (10%, 100%), extraluminal air (8%, 97%), phlegmon (7%, 99%), ileal (3%, 86%) or sigmoid (3%, 95%) wall thickening, and diffuse cecal wall thickening (0%, 91%).
Individual appendiceal CT signs of appendicitis vary in sensitivity, specificity, and thus diagnostic value. An enlarged appendix with periappendiceal fat stranding occurs in 93% of appendicitis CT cases. Less common but specific signs [cecal apical changes, appendolith(s) are usually present in the remaining appendicitis cases. Some signs seen with appendicitis (adenopathy, fat stranding, adjacent bowel wall thickening, fluid) can also be noted with alternative conditions, and in these cases normal appendix identification is the key to excluding appendicitis.
我们的目标是确定螺旋CT阑尾成像中各个征象的敏感性、特异性及诊断价值。
对200例螺旋CT阑尾扫描（100例阑尾炎和100例阑尾正常病例）进行阑尾炎各个征象的解读。扫描结果与阑尾切除术或临床随访结果相关。
识别出的CT征象及其敏感性和特异性分别为：脂肪条纹征（100%，80%）、未强化的阑尾增大（>6mm）（93%，100%）、盲肠顶端局限性增厚（69%，100%）、淋巴结肿大（62%，66%）、阑尾粪石（44%，100%）、箭头征（23%，100%）、结肠旁沟积液（18%，86%）、脓肿（11%，100%）、盲肠条带（10%，100%）、肠腔外气体（8%，97%）、蜂窝织炎（7%，99%）、回肠（3%，86%）或乙状结肠（3%，95%）壁增厚以及盲肠壁弥漫性增厚（0%，91%）。
阑尾炎的各个CT征象在敏感性、特异性及诊断价值方面存在差异。93%的阑尾炎CT病例中出现阑尾增大并伴有阑尾周围脂肪条纹征。较少见但具有特异性的征象（盲肠顶端改变、阑尾粪石）通常出现在其余的阑尾炎病例中。阑尾炎时出现的一些征象（淋巴结肿大、脂肪条纹征、邻近肠壁增厚、积液）在其他情况中也可出现，在这些病例中，识别正常阑尾是排除阑尾炎的关键。
