双源CT鉴别诊断急性阑尾炎和盲肠憩室炎价值分析  

Value of dual source CT in differentiating acute appendicitis and cecal diverticulitis

作　　者：王欢 阮杰 刘娟 谢代军 王明明 卢治兰 WANG Huan;RUAN Jie;LIU Juan;XIE Daijun;WANG Mingming;LU Zhilan(Imaging Center,Ankang Hospital of Traditional Chinese Medicine,Ankang 725000,China)

机构地区：[1]安康市中医医院影像中心,陕西安康725000

出　　处：《陕西医学杂志》2022年第2期215-218,共4页Shaanxi Medical Journal

基　　金：陕西省自然科学基础研究计划项目(2020JM-703)。

摘　　要：目的:探究双源电子计算机断层扫描(CT)鉴别诊断急性阑尾炎和盲肠憩室炎的价值。方法:回顾性分析142例临床疑诊急性阑尾炎患者的临床资料,患者术前均进行双源CT低辐射扫描检查,以术后病理结果为金标准,评价双源CT诊断急性阑尾炎的效能,并分析急性阑尾炎与盲肠憩室炎的双源CT征象。结果:142例患者经手术病理证实急性阑尾炎128例,14例正常阑尾(含10例盲肠憩室炎),以病理结果为金标准,术前双源CT诊断急性阑尾炎的敏感度为90.62%,特异度为85.71%,准确度为90.14%,阳性预测值98.31%,阴性预测值50.00%;急性阑尾炎患者右下腹反跳痛例数多于盲肠憩室炎患者(P<0.05),中性粒细胞百分比水平高于盲肠憩室炎患者(P<0.05);CT征象:急性阑尾炎患者阑尾直径大于盲肠憩室炎患者,腔内积气、腔内积液、腔内结石、局灶盲肠顶端增厚例数、右下象限渗出例数均多于盲肠憩室炎患者(均P<0.05),92.97%急性阑尾炎患者存在阑尾周围渗出而不存在盲肠周围渗出,100.00%盲肠憩室炎患者存在盲肠周围渗出而不存在阑尾周围渗出,两者比较差异有统计学意义(P<0.05)。结论:双源CT检查辐射剂量低,在急性阑尾炎和盲肠憩室炎鉴别诊断中具有较高的效能,临床应用价值较高,值得推广。Objective:To explore the value of dual source computed tomography(CT)in differentiating acute appendicitis and cecal diverticulitis.Methods:The clinical data of 142 patients with clinically suspected acute appendicitis were retrospectively analyzed.All patients were examined by dual source CT low-radiation scan before surgery.Taking postoperative pathological results as gold standards,the efficiency of dual source CT in the diagnosis of acute appendicitis was evaluated,and the dual source CT signs of acute appendicitis and cecal diverticulitis were analyzed.Results:Among 142 patients,128 cases of acute appendicitis and 14 cases of normal appendicitis(including 10 cases of cecal diverticulitis)were confirmed by surgical pathology.Taking the pathological results as the gold standards,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of preoperative dual source CT in the diagnosis of acute appendicitis were 90.62%,85.71%,90.14%,98.31%and 50.00%,respectively.The number of cases with rebound pain in the right lower abdomen among patients with acute appendicitis was more than that among patients with cecal diverticulitis(P<0.05),and the neutrophil percentage was higher than that of patients with cecal diverticulitis(P<0.05).CT signs showed that the appendix diameter of patients with acute appendicitis was longer than that of patients with cecal diverticulitis,and the number of cases with pneumatosis in cavity,effusion in cavity,calculi in cavity,thickening of focal cecum apex and exudation in the lower right quadrant were more than those of patients with cecal diverticulitis(all P<0.05).92.97%of patients with acute appendicitis had exudation around the appendix and no exudation around the cecum.100.00%of patients with cecal diverticulitis had exudation around the cecum and no exudation around the appendix(P<0.05).Conclusion:Dual source CT with low-radiation dose has high diagnostic efficacy and high clinical application value in the differential diagnosis of acute appendicitis

关 键 词：急性阑尾炎 盲肠憩室炎 双源CT 鉴别诊断 影像学特点 诊断效能 

分 类 号：R445.3[医药卫生—影像医学与核医学]