Multidetector CT Feathers of Normal Appendices and Appendices of Acute Appendicitis in Old Patients_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 PENGLi-qing ¹ , ZHOUYou-xing ² , ZHANGXiao ³ , HUANGZi-xing ¹ ,  YUJian-qun ¹ , ZHANGYan ¹

1. Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China;
2. Department of Radiology, People's Hospital of Yongchuan District, Chongqing 402160, China;
3. CT/MRI Room, Leshan People's Hospital, Leshan 614000, Sichuan Province, China;

Corresponding author：

YUJian-qun, Email: cjr.yujianqun@vip.163.com

Keywords：

Acute appendicitis; Multidetector computed tomography; Value

DOI：

10.7507/1007-9424.20160384

Video：

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Objective To analyze the multidetector computed tomography (MDCT) findings of normal appendices and appendices of acute appendicitis in old patients, and to explore the clinical value of MDCT in assessing acute appendicitis in old patients. Methods Sixty-six cases of acute appendicitis confirmed by surgery in 24 hours after MDCT scan from Jun. to Oct. 2016 (acute appendicitis group), and 40 cases underwent MDCT scan for non-abdominal pain causes without appendiceal lesions from Sep. to Oct. 2016 (normal appendices group), were included, and the MDCT images of both 2 groups were retrospectively analyzed. Observation items included:location, diameter, mural thickness, intra-luminal contents, and changes of surrounding structures. Results ① Rate of appendices visualization. In total of 95.5% (63/66) appendices were visualized on MDCT in acute appendicitis group, while 95.0% (38/40) appendices were visualized on MDCT in normal appendices group (P > 0.05). ② Locations of appendices. Acute appendicitis group:appendices were found to be located at pelvic cavity in 22 cases, in front of ileum in 2 cases, behind ileum in 10 cases, below cecum in 25 cases, and behind cecum in 4 cases. Normal appendices group:appendices were found to be located at pelvic cavity in 15 cases, in front of ileum in 3 cases, behind ileum in 7 cases, below cecum in 5 cases, and behind cecum in 8 cases. There was significant difference between 2 groups in terms of location of appendices (P < 0.05). The appendices in acute appendicitis group located mainly at pelvic cavity and below cecum, while the appendices in normal appendices group located mainly at pelvic cavity. ③ The diameter and thickness of appendices. The appendiceal diameter and thickness in acute appendicitis group were (11.4±4.2) mm (6.2-21.9) mm and (4.3±2.2) mm (1.1-8.6) mm, respectively, while those in normal appendices group were (6.1±1.4) mm (3.7-8.6) mm and (1.7±0.8) mm (0.5-3.2) mm, respectively. The diameter and thickness of appendices in acute appendicitis group were significantly greater than those in normal appendices group, respectively (P < 0.05). ④ Contents of appendices. Acute appendices group:there was effusion with air in 14 cases in appendiceal cavity, full of effusion in 36 cases, and appendicolith combined with effusion in 13 cases. Normal appendices group:there was full of air in 15 cases in appendiceal cavity, air with a little faeces of higher density in 13 cases, and nothing in 10 cases. Effusion was more common in appendiceal cavity in acute appendicitis group, while air was more common in normal appendices group. ⑤ Around appendices. Fat stranding was seen in 57 cases, adjacent parietal peritoneum thickening was seen in 56 cases, focal effusion was seen in 18 cases, abscess was seen in 2 cases, free air in peritoneal cavity was seen in 8 cases, and lymphadenopathy was seen in 35 cases. None of these imaging features were seen in normal appendices group. Conclusions MDCT can demonstrate features of normal appendices and acute appendicitis in old patients. MDCT yield high diagnostic accuracy in acute appendicitis in old patients, and can provide useful information before surgery.

Citation： PENGLi-qing, ZHOUYou-xing, ZHANGXiao, HUANGZi-xing, YUJian-qun, ZHANGYan. Multidetector CT Feathers of Normal Appendices and Appendices of Acute Appendicitis in Old Patients. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(12): 1519-1524. doi: 10.7507/1007-9424.20160384 Copy

1.	Cohen-Arazi O, Dabour K, Bala M, et al. Treatment and outcomes of acute appendicitis in an elderly population:a single-center experience. Eur J Trauma Emerg Surg, 2016, [Epub ahead of print].
2.	Bachur RG, Dayan PS, Dudley NC, et al. The influence of age on the diagnostic performance of white blood cell count and absolute neutrophil count in suspected pediatric appendicitis. Acad Emerg Med, 2016, [Epub ahead of print].
3.	刘洪, 高靳.成人急性阑尾炎的MSCT评价.中国中西医结合影像学杂志, 2016, 14(4):471-473.
4.	Keller C, Wang NE, Imler DL, et al. Predictors of nondiagnostic ultrasound for appendicitis. J Emerg Med, 2016, [Epub ahead of print].
5.	Shademan A, Tappouni RF. Pitfalls in CT diagnosis of appendicitis:pictorial essay. J Med Imaging Radiat Oncol, 2013, 57(3):329-336.
6.	刘文, 强金伟, 孙荣勋.多层螺旋CT (MSCT)及多平面重建(MPR)鉴别穿孔与非穿孔性急性阑尾炎(NPAA).复旦学报:医学版, 2013, 40(2):164-168, 186.
7.	郭建国, 徐卫平, 陈新龙.急性阑尾炎的多层螺旋CT表现与病理对照研究.中国医学影像学杂志, 2014, 22(2):149-152.
8.	杨峰, 查云飞, 周静然, 等. 64层螺旋CT平扫和增强诊断成人急性阑尾炎的比较.放射学实践, 2013, 28(12):1275-1278.
9.	陈海燕, 黄娟, 廖方勇, 等.螺旋CT与高频彩超对非典型急性阑尾炎诊断的临床应用价值.西部医学, 2015, 27(4):595-597.
10.	谢国庆.不典型急性阑尾炎的MSCT诊断价值.中国中西医结合影像学杂志, 2013, 11(6):696-697.
11.	刘洪, 高靳, 周瀚, 等.成人急性阑尾炎病变阑尾解剖位置的多层螺旋CT评价.四川医学, 2016, 37(7):823-825.
12.	何六兵, 肖静, 雷启东.超声对急性阑尾炎漏诊原因的分析.临床医药文献电子杂志, 2015, 2(15):3084-3085.
13.	杨旋彪, 薛春升, 庄凯帆, 等.多层螺旋CT在正常阑尾中的应用研究.现代医用影像学, 2013, 22(3):176-178.
14.	甘雄辉, 韦力谦.重视正常阑尾CT影像对鉴别急性阑尾炎的价值.临床急诊杂志, 2013, 14(9):412-414.
15.	胡爱武, 徐亮, 龚建平.急性阑尾炎与正常阑尾的螺旋CT对比研究.苏州大学学报:医学版, 2009, 29(1):157-158, 164.
16.	赵晓霞.超声与CT在急性阑尾炎诊断中的应用价值.河北医药, 2013, 35(2):257-258.
17.	Huwart L, El Khoury M, Lesavre A, et al. What is the thickness of the normal appendix on MDCT? J Radiol, 2007, 88(3 Pt 1):385-389.
18.	刘希孟.误诊为急性阑尾炎21例分析.中国普外基础与临床杂志, 2010, 17(5):498-499.
19.	赵龙, 朱安龙, 朴大勋, 等.继发性阑尾炎的诊断和治疗(附66例报道).中国普外基础与临床杂志, 2010, 17(9):932-935.
20.	张伟耀, 邓惠玲, 朱峰正, 等.急性阑尾炎CT检查的辅助诊断价值及鉴别诊断思路.中国普外基础与临床杂志, 2013, 20(12):1414-1416.
21.	靳忠民, 苏虹, 李楠.应用高频超声显像诊断急性阑尾炎的临床价值再探讨.中国超声医学杂志, 2012, 24(6):69-72.
22.	周杨, 王雪松, 冯晓曦.多层螺旋CT与超声检查在急性阑尾炎术前中的应用价值.中国CT和MRI杂志, 2016, 14(2):118-120.
23.	石尖兵, 王凌, 欧华林, 等.超声与CT在急性阑尾炎临床应用中的对比研究.中华临床医师杂志:电子版, 2010, 4(2):211-214.
24.	王振芳, 岳学旺, 毕言刚, 等.急性阑尾炎超声与64排螺旋CT检查对比分析.实用放射学杂志, 2014, 30(7):1154-1156.
25.	张彦彩, 朱小忠.螺旋CT低剂量扫描研究进展.中国医学影像技术, 2010, 26(7):1376-1378.
26.	刘彬, 乔磊, 白玫. CT低剂量技术新进展.中国医学装备, 2012, 9(8):48-51.

1. Cohen-Arazi O, Dabour K, Bala M, et al. Treatment and outcomes of acute appendicitis in an elderly population:a single-center experience. Eur J Trauma Emerg Surg, 2016, [Epub ahead of print].
2. Bachur RG, Dayan PS, Dudley NC, et al. The influence of age on the diagnostic performance of white blood cell count and absolute neutrophil count in suspected pediatric appendicitis. Acad Emerg Med, 2016, [Epub ahead of print].
3. 刘洪, 高靳.成人急性阑尾炎的MSCT评价.中国中西医结合影像学杂志, 2016, 14(4):471-473.
4. Keller C, Wang NE, Imler DL, et al. Predictors of nondiagnostic ultrasound for appendicitis. J Emerg Med, 2016, [Epub ahead of print].
5. Shademan A, Tappouni RF. Pitfalls in CT diagnosis of appendicitis:pictorial essay. J Med Imaging Radiat Oncol, 2013, 57(3):329-336.
6. 刘文, 强金伟, 孙荣勋.多层螺旋CT (MSCT)及多平面重建(MPR)鉴别穿孔与非穿孔性急性阑尾炎(NPAA).复旦学报:医学版, 2013, 40(2):164-168, 186.
7. 郭建国, 徐卫平, 陈新龙.急性阑尾炎的多层螺旋CT表现与病理对照研究.中国医学影像学杂志, 2014, 22(2):149-152.
8. 杨峰, 查云飞, 周静然, 等. 64层螺旋CT平扫和增强诊断成人急性阑尾炎的比较.放射学实践, 2013, 28(12):1275-1278.
9. 陈海燕, 黄娟, 廖方勇, 等.螺旋CT与高频彩超对非典型急性阑尾炎诊断的临床应用价值.西部医学, 2015, 27(4):595-597.
10. 谢国庆.不典型急性阑尾炎的MSCT诊断价值.中国中西医结合影像学杂志, 2013, 11(6):696-697.
11. 刘洪, 高靳, 周瀚, 等.成人急性阑尾炎病变阑尾解剖位置的多层螺旋CT评价.四川医学, 2016, 37(7):823-825.
12. 何六兵, 肖静, 雷启东.超声对急性阑尾炎漏诊原因的分析.临床医药文献电子杂志, 2015, 2(15):3084-3085.
13. 杨旋彪, 薛春升, 庄凯帆, 等.多层螺旋CT在正常阑尾中的应用研究.现代医用影像学, 2013, 22(3):176-178.
14. 甘雄辉, 韦力谦.重视正常阑尾CT影像对鉴别急性阑尾炎的价值.临床急诊杂志, 2013, 14(9):412-414.
15. 胡爱武, 徐亮, 龚建平.急性阑尾炎与正常阑尾的螺旋CT对比研究.苏州大学学报:医学版, 2009, 29(1):157-158, 164.
16. 赵晓霞.超声与CT在急性阑尾炎诊断中的应用价值.河北医药, 2013, 35(2):257-258.
17. Huwart L, El Khoury M, Lesavre A, et al. What is the thickness of the normal appendix on MDCT? J Radiol, 2007, 88(3 Pt 1):385-389.
18. 刘希孟.误诊为急性阑尾炎21例分析.中国普外基础与临床杂志, 2010, 17(5):498-499.
19. 赵龙, 朱安龙, 朴大勋, 等.继发性阑尾炎的诊断和治疗(附66例报道).中国普外基础与临床杂志, 2010, 17(9):932-935.
20. 张伟耀, 邓惠玲, 朱峰正, 等.急性阑尾炎CT检查的辅助诊断价值及鉴别诊断思路.中国普外基础与临床杂志, 2013, 20(12):1414-1416.
21. 靳忠民, 苏虹, 李楠.应用高频超声显像诊断急性阑尾炎的临床价值再探讨.中国超声医学杂志, 2012, 24(6):69-72.
22. 周杨, 王雪松, 冯晓曦.多层螺旋CT与超声检查在急性阑尾炎术前中的应用价值.中国CT和MRI杂志, 2016, 14(2):118-120.
23. 石尖兵, 王凌, 欧华林, 等.超声与CT在急性阑尾炎临床应用中的对比研究.中华临床医师杂志:电子版, 2010, 4(2):211-214.
24. 王振芳, 岳学旺, 毕言刚, 等.急性阑尾炎超声与64排螺旋CT检查对比分析.实用放射学杂志, 2014, 30(7):1154-1156.
25. 张彦彩, 朱小忠.螺旋CT低剂量扫描研究进展.中国医学影像技术, 2010, 26(7):1376-1378.
26. 刘彬, 乔磊, 白玫. CT低剂量技术新进展.中国医学装备, 2012, 9(8):48-51.

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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Multidetector CT Feathers of Normal Appendices and Appendices of Acute Appendicitis in Old Patients

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