摘要
目的探讨超声(US)检查在CT检查未确诊的疑似急性阑尾炎(AA)中的诊断效能。方法46例疑似AA患者,CT检查未确诊,行US检查。以手术后的病理检查为金标准,绘制受试者工作特性曲线(ROC曲线)测算US检查诊断AA的敏感度(SE)、特异度(SP)、准确率(AC)、阳性预测值(PPV)、阴性预测量(NPV)。结果46例疑似AA患者最终手术后、病理证实为AA 19例(41%)、非AA 27(59%)例。46例疑似AA患者US再评估后确诊为AA 18例、非AA 28例。与金标准比较,1例假阴性患者的病理诊断为阑尾局灶性急性单纯性阑尾炎,中性粒细胞浸润黏膜溃疡金局限于黏膜层。对于CT检查未确诊的疑似AA患者,US检查诊断的效能为AC 97.8%、SE 94.7%、SP 100%、PPV 100%、NPV 96.4%。不可压缩的阑尾、阑尾壁血流增强征象是US检查在CT检查未确诊疑似AA确诊的特征性表现(OR分别为22.91、15.81;95%CI分别为2.63~199.24,2.87~87.25;P<0.05)。结论US再评估CT检查未确诊疑似AA的诊断特异度、敏感度、准确率均较高。“不可压缩阑尾”和“阑尾壁血流信号增强”是US检查在CT检查未确诊疑似AA的特征性表现。
Objective To investigate the diagnostic efficacy of ultrasonography(US)in suspected acute appendicitis(AA)patients who can not be confirmed by CT examination.Methods Forty-six suspected AA patients,without definite diagnosis in CT examination,underwent US.Using the pathological examination after surgery as the gold standard,the sensitivity(SE),specificity(SP),accuracy(AC),positive predictive value(PPV),and negative predictive value(NPV)of the US for suspected AA which was not clearly diagnosed by CT examination were calculated according to the ROC curve.Results Through surgical pathology,19 cases(41%)of suspected AA patients were confirmed as AA and 27 cases(59%)as non-AA.After reassessment,18 cases among 46 suspected AA patients were confirmed as AA and 28 cases as non-AA.Compared with the gold standard,the pathological diagnosis of 1 false negative patient was acute appendicitis with focal acute simple appendicitis,and the gold of ulcer with neutrophil infiltration mucosa was confined to the mucosa.For suspected AA patients who were not confirmed by CT examination,the AC of US was 97.8%,SE 94.7%,SP 100%,PPV 100%and NPV 96.4%.Signs of incompressible appendix and increased blood flow in the appendix wall were characteristic manifestations of suspected AA without CT examination in US reassessment(OR=22.91 and 15.81,respectively;95%CI=2.63-199.24 and 2.87-87.25,respectively;both P<0.05)Conclusions The diagnostic SP,SE and AC of US reassessment for suspected AA in unconfirmed CT examination are high.Incompressible appendix and enhanced blood flow signal of appendix wall are the characteristic manifestations of US on suspected AA without confirmation of CT examination.
作者
焦健
都基权
孟玫
邹淑丽
张鹏
JIAO Jian;DU Jiquan;MENG Mei;ZOU Shuli;ZHANG Peng(Shandong Armed Police Corps Hospital,Jinan 250014,China)
出处
《山东医药》
CAS
2020年第18期89-91,共3页
Shandong Medical Journal
关键词
体层射影术
X线计算机
超声
急性阑尾炎
Tomography
X-ray computed
Ultrasonography
Acute appendicitis
作者简介
通信作者:张鹏(E-mail:13698648252@163.com)。