CT differential diagnosis of adenoma and carcinoid of appendix
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摘要:
目的研究对阑尾粘液囊腺瘤和类癌的CT鉴别诊断。 方法选择50例阑尾粘液囊腺瘤患者和20例类癌患者，其中男性32例，女性38例，年龄57.15±5.28岁。通过CT检测成像系统检测阑尾粘液囊腺瘤和类癌表现症状，对患者阑尾图像阑尾壁厚度、直径、钙化情况、周围侵犯情况、阑尾壁增厚、壁异常强化、粪石发生率以及检出率和准确率进行对比分析，同时对CT检测异质性分析和相关影响因素进行总结。 结果阑尾粘液囊腺瘤和类癌患者CT检查图像中阑尾壁厚度、直径、钙化情况、周围侵犯情况、阑尾壁增厚、壁异常强化、粪石发生率以及检出率和准确率的差异存在统计学意义（P<0.01），且类癌组患者较囊腺瘤组患者症状更显著。异质性检测结果显示，类癌组的敏感度、特异度、阳性比、阴性比和诊断比值比最大，且病程、年龄和发病范围与CT评估阑尾粘液囊腺瘤和类癌诊断价值的相关性最高，而囊腺瘤体积与CT评估阑尾粘液囊腺瘤和类癌诊断价值的相关性较低。 结论CT鉴别诊断阑尾粘液囊腺瘤和类癌的价值较高，值得临床应用广泛推广。 Abstract:ObjectiveTo explore the CT differential diagnosis of mucinous cystadenoma and carcinoid of appendix. MethodsWe choosed 50 cases of patients with appendiceal mucous cystadenoma and 20 cases of patients with carcinoid. There were 32 males and 38 females with an average age of 57.15±5.28 years old. We analyzed image of patients appendix appendiceal wall thickness, diameter, calcification, infringement, appendix around abnormal wall thickening, wall reinforcement, incidence of bezoar and detection rate and accuracy by CT detection imaging system mucous cystadenoma and carcinoid appendix presenting symptoms. The CT detection heterogeneity analysis and related influence factors were analyzed. ResultsThere were significant differences between the CT images of the patients with appendiceal mucinous adenoma and carcinoid in the thickness, diameter, calcification, peripheral invasion, wall thickening, abnormal wall strengthening, fecality incidence, detection rate and accuracy (P<0.05). The patients in the carcinoid group had more significant symptoms than those in the cystadenoma group. The sensitivity of the carcinoid group, specific degrees, masculine, feminine and diagnostic odds ratio was the largest. The course, age and disease range and CT evaluation carcinoid appendix mucous cystadenoma, and diagnostic value of the highest correlation, and the capsule gland tumors had product and evaluation of CT carcinoid appendix mucous cystadenoma and diagnostic value of correlation were low. ConclusionCT has a high value in the differential diagnosis of appendiceal mucinous cystadenoma and carcinoid. -
Key words:
- appendiceal burs adenoma /
- type of cancer /
- CT identification /
- diagnostic studies
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图 1 阑尾粘液囊肿患者CT表现
A：患者表现为阑尾粘液囊肿，壁薄光整，伴有阑尾周围炎征象；B：患者表现为阑尾粘液囊肿正常，阑尾远端囊性肿块，周围脂肪间隙清晰；C：患者表现为阑尾粘液囊腺瘤，囊肿5 cm，周围存在脂肪条纹征；D：患者表现为阑尾粘液囊腺瘤伴急性阑尾炎，阑尾远端呈囊实性肿块，囊壁明显强化，周围脂肪条纹征；E：患者表现为阑尾粘液囊腺癌，阑尾远端囊实性肿块，壁结节强化明显.
Figure 1. CT manifestations of appendicitis mucocyst
图 2 阑尾类癌患者CT表现
阑尾类癌合并急性阑尾炎CT示增粗的阑尾（箭头表示增粗肿胀的阑尾，周围大量粘液渗出，且呈明显结节状强化，直径约1 cm）。
Figure 2. CT manifestations of carcinoid of appendix
表 1 患者CT检查阑尾图像直径、阑尾壁厚度、钙化情况以及周围侵犯情况
Table 1. Appendix image diameter, appendix wall thickness, calcification and surrounding invasion of patients in CT detection
组别 直径（cm） 阑尾壁厚度（%） 是否钙化（%） 周围侵犯情况（%） 囊腺瘤组（n=50） 1~3 52 42 62 类癌组（n=20） 3~10 68 46 76 t 2.395 2.141 2.139 2.054 P 0.005 0.001 0.012 0.001 
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表 2 患者CT检查阑尾图像阑尾壁增厚、壁异常强化及粪石发生率
Table 2. Appendiceal wall thickening, wall abnormal strengthening and the incidence of faecal stone examined by CT
组别 阑尾壁增厚（%） 壁异常强化（%） 粪石发生率（%） 囊腺瘤组（n=50） 52 42 62 类癌组（n=20） 74 52 66 t 2.167 3.139 1.284 P 0.001 0.012 0.001
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表 3 CT鉴别诊断检出前阑尾粘液囊腺瘤和类癌的结果
Table 3. CT results of differential diagnosis of anterior appendicitis mucinous cystadenoma and carcinoid carcinoma
组别 检出率（%） 准确率（%） 囊腺瘤组（n=50） 90.56 85.32 类癌组（n=20） 95.68 90.26 t 8.265 6.387 P 0.006 0.009
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表 4 CT评估阑尾粘液囊腺瘤和类癌的异质性检测
Table 4. Heterogeneity of CT assessment of adenoma and carcinoid carcinoma of the appendicular mucus capsule
组别 敏感度 特异度 阳性比 阴性比 诊断比值比 囊腺瘤组（n=50） 0.83 0.81 4.21 0.19 23.65 类癌组（n=20） 0.95 0.86 5.56 0.23 56.12 t 7.145 8.236 6.114 7.265 8.221 P 0.002 0.001 0.012 0.025 0.002
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表 5 影响CT评估阑尾粘液囊腺瘤和类癌诊断价值的相关因素分析
Table 5. Analysis of relevant factors affecting CT assessment of diagnostic value of appendicitis mucinous cystadenoma and carcinoid
相关因素 囊腺瘤体积 病程 年龄 发病范围 囊腺瘤体积 3.265 1.456 3.214 3.113 病程 1.256 1.254 3.265 3.244 年龄 1.256 1.225 5.689 7.012 发病范围 1.632 2.564 2.336 1.236 F 2.564 7.214 10.112 9.264 P 0.012 0.006 0.006 0.002
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