CAJ | 학술논문

目的探讨MSCT对早期急性阑尾炎(AA)的诊断价值.方法回顾性分析2008年6月至2011年6月期间,经手术病理证实的41例急性单纯性阑尾炎的MSCT扫描资料；并将同期因病情需要行MSCT检查,且经临床证实为正常阑尾的36例患者作为对照组,其中复杂病变正常阑尾(CNA)组18例,非复杂病变正常阑尾(NCNA)组18例.采用MPR和CPR法进行后处理显示阑尾,观察测量早期AA与正常阑尾在阑尾直径、壁厚度、腔内液体最大直径(MDIAF)、壁异常强化、粪石和周围情况的差异,并采用方差分析、秩和检验和卡方检验进行比较.结果早期AA组、CNA组和NCNA组患者的阑尾壁厚度分别为(2.88±0.62)、(2.58±0,50)和(2.73±0.53) mm,差异无统计学意义(F=1.73,P=0.19)；直径分别为(11.37±1.94)、(7.03±0.89)和(6.75±0.63) mm,MDIAF中位数分别为4.05(2.65 ～8.50)、1.68(0 ～4.40)和0.00(0 ～ 1.90) mm,差异均有统计学意义(Z值分别为7.02和7.24,P值均为0.00).上述3组CT增强扫描阑尾壁异常强化的发生率分别为61.1％(11/18)、16.7％(3/18)和11.1％(2/18),早期AA组与正常阑尾组差异有统计学意义(x2=12.83,P=0.00).当阑尾直径和MDIAF的界值分别为7.8和2.6 mm时,诊断早期AA的敏感度、特异度和准确度分别为97.6％ (40/41)、91.7％(33/36)、94.8％(73/77)和100.0％(36/36)、88.9％(32/36)、94.4％(68/72).结论 MSCT在诊断早期AA具有价值,当阑尾直径＞7.8 mm、MDIAF＞ 2.6 mm时,可早期诊断AA.
목적 탐토MSCT대조기급성란미염(AA)적진단개치.방법 회고성분석2008년6월지2011년6월기간,경수술병리증실적41례급성단순성란미염적MSCT소묘자료；병장동기인병정수요행MSCT검사,차경림상증실위정상란미적36례환자작위대조조,기중복잡병변정상란미(CNA)조18례,비복잡병변정상란미(NCNA)조18례.채용MPR화CPR법진행후처리현시란미,관찰측량조기AA여정상란미재란미직경、벽후도、강내액체최대직경(MDIAF)、벽이상강화、분석화주위정황적차이,병채용방차분석、질화검험화잡방검험진행비교.결과 조기AA조、CNA조화NCNA조환자적란미벽후도분별위(2.88±0.62)、(2.58±0,50)화(2.73±0.53) mm,차이무통계학의의(F=1.73,P=0.19)；직경분별위(11.37±1.94)、(7.03±0.89)화(6.75±0.63) mm,MDIAF중위수분별위4.05(2.65 ～8.50)、1.68(0 ～4.40)화0.00(0 ～ 1.90) mm,차이균유통계학의의(Z치분별위7.02화7.24,P치균위0.00).상술3조CT증강소묘란미벽이상강화적발생솔분별위61.1％(11/18)、16.7％(3/18)화11.1％(2/18),조기AA조여정상란미조차이유통계학의의(x2=12.83,P=0.00).당란미직경화MDIAF적계치분별위7.8화2.6 mm시,진단조기AA적민감도、특이도화준학도분별위97.6％ (40/41)、91.7％(33/36)、94.8％(73/77)화100.0％(36/36)、88.9％(32/36)、94.4％(68/72).결론 MSCT재진단조기AA구유개치,당란미직경＞7.8 mm、MDIAF＞ 2.6 mm시,가조기진단AA.
Objective To investigate the value of multi-slice CT (MSCT) in diagnosing early acute appendicitis (AA).Methods From June 2008 to June 2011,abdomen MSCT images of 41 patients with acute simple appendicitis confirmed by surgery and pathology were evaluated retrospectively. Thirty-six patients with clinically confirmed normal appendix served as the control groups with 18 patients in complicated-normal-appendix (CNA) group and 18 patients in noncomplicated-normal-appendix (NCNA)group. The appendix was reconstructed by using multiplanar reformation (MPR) and curved planar reformation (CPR) techniques. The differences between early AA and normal appendix in appendiceal diameter,thickness of the appendiceal wall, maximum depth of the intraluminal appendiceal fluid (MDIAF), abnormal enhancement of the appendiceal wall, appendicolith and the periappendiceal abnormalities were evaluated and compared by using analysis of variance,R test and Chi-square test.Results The mean thickness of the appendiceal wall was (2.88 ±0.62),(2.58 -±0.50) and (2.73 ±0.53) mm in early AA,CNA and NCNA groups respectively,with no statistically significant difference among them ( F =1.73,P=0.19).The nean appendiceal diameter was (11.37 ± 1.94),(7.03 -±0.89),(6.75 ±0.63) mm,and median MDIAF was 4.05 (2.65-8.50),1.68 (0-.40),0 (0-1.90) mm in early AA,CNA and NCNA groups respectively,with statistically significant differences between early AA and the two normal appendix groups ( Z =7.02,7.24 ; P =0.00 ).The abnormal enhancement of appendiceal wall was found in 61.1％ (11/18) of early AA,16.7％ (3/18) of CNA and 11.1％ (2/18) of NCNA groups respectively,with statistically significant differences between early AA and the two normal appendix groups (x2 =12.83,P =0.00). Using a cutoff value of 7.8 mm of the appendiceal diameter and 2.6 mm of MDIAF for the early AA,the sensitivity,specificity and accuracy were 97.6％ (40/41),91.7％ (33/36) and 94.8％ (73/77),and 100.0％ (36/36),88.9％ (32/36) and 94.4％ (68/72),respectively.Conclusions MSCT is particularly useful for the diagnosis of early AA. When appendiceal diameter is greater than 7.8 mm,and MDIAF greater than 2.6mm,early AA can be diagnosed with confidence.