Three-dimensional reconstruction of multi-slice spiral CT has high efficacy in differential diagnosis of cecal diverticulitis and acute appendicitis
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摘要:
目的 探究多层螺旋CT鉴别诊断盲肠憩室炎和急性阑尾炎的价值。 方法 选取2020年1月~2023年9月于长沙医学院附属第一医院、临湘市人民医院和益阳市第三人民医院收治的128例临床疑诊为急性阑尾炎的患者病历资料进行回顾性分析，患者术前均进行CT平扫和三维重建图像处理。以术后的病理结果或出院诊断为金标准，深度探究多层螺旋CT三维重建技术诊断盲肠憩室炎和急性阑尾炎的临床应用价值，分析两者的鉴别要点。 结果 128例患者经手术病理或出院治疗结果证实急性阑尾炎49例，盲肠憩室炎41例，急性阑尾炎合并盲肠憩室炎21例，正常人17例。术前多层螺旋CT三维重建技术诊断盲肠憩室炎的准确度为96%；诊断急性阑尾炎的准确度为98.25%；诊断急性阑尾炎合并盲肠憩室炎的准确度为100%。CT征象：急性阑尾炎患者的阑尾增粗的比例高于盲肠憩室炎，差异有统计学意义（P < 0.05）；89.80%的阑尾炎患者阑尾周围有渗出而盲肠周围无渗出，82.93%的盲肠憩室炎患者盲肠周围有渗出而阑尾周围无渗出。 结论 多层螺旋CT三维重建技术在急性阑尾炎和盲肠憩室炎的鉴别诊断中有较高的效能，并且能对临床治疗方式的选择提供指导性意见。 -
关键词:
- 急性阑尾炎 /
- 盲肠憩室炎 /
- 多层螺旋CT三维重建技术 /
- 鉴别诊断
Abstract:Objective To explore the value of multi-slice spiral CT in the differential diagnosis of cecal diverticulitis and acute appendicitis. Methods A total of 128 cases of suspected acute appendicitis admitted to the First Affiliated Hospital of Changsha Medical College, Linxiang People's Hospital and Yiyang Third People's Hospital from January 2020 to September 2023 were retrospectively analyzed. All patients underwent CT plain scan and 3D reconstruction image processing before surgery. With postoperative pathological results or discharge diagnosis as the gold standard, the clinical application value of three- dimensional reconstruction of multi- slice spiral CT in the diagnosis of cecal diverticulitis and acute appendicitis was deeply explored, and the key points of differentiation between the two were analyzed. Results Among the 128 patients, 49 cases of acute appendicitis, 41 cases of cecal diverticulitis, 21 cases of acute appendicitis combined with cecal diverticulitis and 17 cases of normal people were confirmed by operation, pathology or discharge treatment. The accuracy of three-dimensional multi-slice CT in the diagnosis of cecal diverticulitis was 96%. The accuracy of diagnosis of acute appendicitis was 98.25%. The accuracy of diagnosis of acute appendicitis with cecal diverticulitis was 100%. CT signs: The proportion of appendicitis enlargement in patients with acute appendicitis was significantly higher than that with cecal diverticulitis, with statistical significance (P < 0.05). 89.80% of appendicitis patients had periappendicular exudation but no exudation around the cecum, 82.93% of cecal diverticulitis patients had periappendicular exudation but no exudation around the appendix. Conclusion Multi-slice spiral CT 3D reconstruction technique has high efficacy in the differential diagnosis of acute appendicitis and cecal diverticulitis, and can provide guidance for the selection of clinical treatment. -
图 1 盲肠憩室炎多层螺旋CT三维成像
Figure 1. Multislice spiral CT three-dimensional imaging of cecal diverticulitis.
表 1 多层螺旋CT三维重建、CT平扫诊断急性阑尾炎的效能分析
Table 1. Efficacy analysis of multi-slice spiral CT 3D reconstruction and CT plain scan in the diagnosis of acute appendicitis (n)
Detection mode Histopathological examination results Total Positive Negative Plain CT scan Positive 49 6 55 Negative 0 2 2 Multi-slice spiral CT 3D reconstruction Positive 54 1 55 Negative 0 2 2 
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表 2 多层螺旋CT三维重建、CT平扫诊断急性阑尾炎的效能比较
Table 2. Comparison of efficacy of three-dimensional reconstruction of multi-slice spiral CT and plain CT scan in the diagnosis of acute appendicitis (%)
Detection mode Sensitivity Specificity Accuracy Misdiagnosis rate False dismissal rate Plain CT scan 100.00 25.00 89.47 75.00 0.00 Multi-slice spiral CT 3D reconstruction 100.00 66.66 98.25 33.33 0.00
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表 3 多层螺旋CT三维重建、CT平扫诊断盲肠憩室炎的效能分析
Table 3. Efficacy analysis of multi-slice spiral CT 3D reconstruction and CT plain scan in the diagnosis of cecal diverticulitis (n)
Detection mode Histopathological examination results Total Positive Negative Plain CT scan Positive 37 0 37 Negative 6 7 13 Multi-slice spiral CT 3D reconstruction Positive 41 0 41 Negative 2 7 9
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表 4 多层螺旋CT三维重建、CT平扫诊断盲肠憩室炎的效能比较
Table 4. Comparison of the efficacy of three- dimensional multi- slice spiral CT reconstruction and CT plain scan in the diagnosis of cecal diverticulitis (%)
Detection mode Sensitivity Specificity Accuracy Misdiagnosis rate False dismissal rate Plain CT scan 86.64 100.00 88.00 0.00 13.95 Multi-slice spiral CT 3D reconstruction 95.34 100.00 96.00 0.00 4.65
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表 5 多层螺旋CT三维重建、CT平扫诊断急性阑尾炎合并盲肠憩室炎的效能分析
Table 5. Effect analysis of multi- slice spiral CT 3D reconstruction and CT plain scan in the diagnosis of acute appendicitis complicated with cecal diverticulitis (n)
Detection mode Histopathological examination results Total Positive Negative Plain CT scan Positive 16 1 17 Negative 0 4 4 Multi-slice spiral CT 3D reconstruction Positive 17 0 17 Negative 0 4 4
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表 6 多层螺旋CT三维重建、CT平扫诊断急性阑尾炎合并盲肠憩室炎的效能比较
Table 6. Comparison of efficacy of three-dimensional multi-slice spiral CT reconstruction and CT plain scan in the diagnosis of acute appendicitis complicated with cecal diverticulitis (%)
Detection mode sensitivity specificity accuracy Misdiagnosis rate false dismissal rate Plain CT scan 100.00 80.00 95.23 2.00 0.00 Multi-slice spiral CT 3D reconstruction 100.00 100.00 100.00 0.00 0.00
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表 7 急性阑尾炎和盲肠憩室炎临床症状及体征
Table 7. Clinical symptoms and signs of acute appendicitis and cecal diverticulitis [n(%)]
Item Acute appendicitis (n=49) Cecal diverticulitis (n=41) χ2 P Nausea and vomiting 13（26.53） 0（0.00） 4.309 < 0.01 Fever 15（30.61） 0（0.00） 4.804 < 0.01 Metastatic abdominal pain 46（93.88） 3（7.32） 22.509 < 0.01 Abdominal tension 39（79.59） 6（14.63） 12.845 < 0.01 Pressing pain 45（91.84） 32（78.05） 3.354 < 0.01 Rebound pain 43（87.76） 12（29.27） 9.832 < 0.01 Radiating pain 3（6.12） 0（0.00） 1.777 0.083
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表 8 急性阑尾炎和盲肠憩室炎患者CT征象比较
Table 8. Comparison of CT findings in patients with acute appendicitis and cecal diverticulitis [n(%)]
Item Acute appendicitis (n=49) Cecal diverticulitis (n=41) χ2 P Appendiceal thickening 45（91.84） 2（4.88） 27.928 < 0.01 Intracavitary gas 2（4.08） 6（14.63） -2.080 < 0.05 Intracavitary fluid 2（4.08） 0（0.00） 1.432 0.160 Fecal shadow 11（22.45） 2（4.88） 3.354 < 0.01 Pericecal exudation 5（10.20） 34（82.93） -9.832 < 0.01 Periappendiceal exudation 44（89.80） 2（4.88） 27.928 < 0.01 Bag-like protrusions around the wall of the cecum 0（0.00） 41（100.00） - - Blind ascending colon wall thickening 0（0.00） 10（24.39） -3.592 < 0.01
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