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.	劉洪, 高靳.成人急性闌尾炎的MSCT評價.中國中西醫結合影像學雜志, 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.	劉文, 強金偉, 孫榮勛.多層螺旋CT (MSCT)及多平面重建(MPR)鑒別穿孔與非穿孔性急性闌尾炎(NPAA).復旦學報:醫學版, 2013, 40(2):164-168, 186.
7.	郭建國, 徐衛平, 陳新龍.急性闌尾炎的多層螺旋CT表現與病理對照研究.中國醫學影像學雜志, 2014, 22(2):149-152.
8.	楊峰, 查云飛, 周靜然, 等. 64層螺旋CT平掃和增強診斷成人急性闌尾炎的比較.放射學實踐, 2013, 28(12):1275-1278.
9.	陳海燕, 黃娟, 廖方勇, 等.螺旋CT與高頻彩超對非典型急性闌尾炎診斷的臨床應用價值.西部醫學, 2015, 27(4):595-597.
10.	謝國慶.不典型急性闌尾炎的MSCT診斷價值.中國中西醫結合影像學雜志, 2013, 11(6):696-697.
11.	劉洪, 高靳, 周瀚, 等.成人急性闌尾炎病變闌尾解剖位置的多層螺旋CT評價.四川醫學, 2016, 37(7):823-825.
12.	何六兵, 肖靜, 雷啟東.超聲對急性闌尾炎漏診原因的分析.臨床醫藥文獻電子雜志, 2015, 2(15):3084-3085.
13.	楊旋彪, 薛春升, 莊凱帆, 等.多層螺旋CT在正常闌尾中的應用研究.現代醫用影像學, 2013, 22(3):176-178.
14.	甘雄輝, 韋力謙.重視正常闌尾CT影像對鑒別急性闌尾炎的價值.臨床急診雜志, 2013, 14(9):412-414.
15.	胡愛武, 徐亮, 龔建平.急性闌尾炎與正常闌尾的螺旋CT對比研究.蘇州大學學報:醫學版, 2009, 29(1):157-158, 164.
16.	趙曉霞.超聲與CT在急性闌尾炎診斷中的應用價值.河北醫藥, 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.	劉希孟.誤診為急性闌尾炎21例分析.中國普外基礎與臨床雜志, 2010, 17(5):498-499.
19.	趙龍, 朱安龍, 樸大勛, 等.繼發性闌尾炎的診斷和治療(附66例報道).中國普外基礎與臨床雜志, 2010, 17(9):932-935.
20.	張偉耀, 鄧惠玲, 朱峰正, 等.急性闌尾炎CT檢查的輔助診斷價值及鑒別診斷思路.中國普外基礎與臨床雜志, 2013, 20(12):1414-1416.
21.	靳忠民, 蘇虹, 李楠.應用高頻超聲顯像診斷急性闌尾炎的臨床價值再探討.中國超聲醫學雜志, 2012, 24(6):69-72.
22.	周楊, 王雪松, 馮曉曦.多層螺旋CT與超聲檢查在急性闌尾炎術前中的應用價值.中國CT和MRI雜志, 2016, 14(2):118-120.
23.	石尖兵, 王凌, 歐華林, 等.超聲與CT在急性闌尾炎臨床應用中的對比研究.中華臨床醫師雜志:電子版, 2010, 4(2):211-214.
24.	王振芳, 岳學旺, 畢言剛, 等.急性闌尾炎超聲與64排螺旋CT檢查對比分析.實用放射學雜志, 2014, 30(7):1154-1156.
25.	張彥彩, 朱小忠.螺旋CT低劑量掃描研究進展.中國醫學影像技術, 2010, 26(7):1376-1378.
26.	劉彬, 喬磊, 白玫. CT低劑量技術新進展.中國醫學裝備, 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. 劉洪, 高靳.成人急性闌尾炎的MSCT評價.中國中西醫結合影像學雜志, 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. 劉文, 強金偉, 孫榮勛.多層螺旋CT (MSCT)及多平面重建(MPR)鑒別穿孔與非穿孔性急性闌尾炎(NPAA).復旦學報:醫學版, 2013, 40(2):164-168, 186.
7. 郭建國, 徐衛平, 陳新龍.急性闌尾炎的多層螺旋CT表現與病理對照研究.中國醫學影像學雜志, 2014, 22(2):149-152.
8. 楊峰, 查云飛, 周靜然, 等. 64層螺旋CT平掃和增強診斷成人急性闌尾炎的比較.放射學實踐, 2013, 28(12):1275-1278.
9. 陳海燕, 黃娟, 廖方勇, 等.螺旋CT與高頻彩超對非典型急性闌尾炎診斷的臨床應用價值.西部醫學, 2015, 27(4):595-597.
10. 謝國慶.不典型急性闌尾炎的MSCT診斷價值.中國中西醫結合影像學雜志, 2013, 11(6):696-697.
11. 劉洪, 高靳, 周瀚, 等.成人急性闌尾炎病變闌尾解剖位置的多層螺旋CT評價.四川醫學, 2016, 37(7):823-825.
12. 何六兵, 肖靜, 雷啟東.超聲對急性闌尾炎漏診原因的分析.臨床醫藥文獻電子雜志, 2015, 2(15):3084-3085.
13. 楊旋彪, 薛春升, 莊凱帆, 等.多層螺旋CT在正常闌尾中的應用研究.現代醫用影像學, 2013, 22(3):176-178.
14. 甘雄輝, 韋力謙.重視正常闌尾CT影像對鑒別急性闌尾炎的價值.臨床急診雜志, 2013, 14(9):412-414.
15. 胡愛武, 徐亮, 龔建平.急性闌尾炎與正常闌尾的螺旋CT對比研究.蘇州大學學報:醫學版, 2009, 29(1):157-158, 164.
16. 趙曉霞.超聲與CT在急性闌尾炎診斷中的應用價值.河北醫藥, 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. 劉希孟.誤診為急性闌尾炎21例分析.中國普外基礎與臨床雜志, 2010, 17(5):498-499.
19. 趙龍, 朱安龍, 樸大勛, 等.繼發性闌尾炎的診斷和治療(附66例報道).中國普外基礎與臨床雜志, 2010, 17(9):932-935.
20. 張偉耀, 鄧惠玲, 朱峰正, 等.急性闌尾炎CT檢查的輔助診斷價值及鑒別診斷思路.中國普外基礎與臨床雜志, 2013, 20(12):1414-1416.
21. 靳忠民, 蘇虹, 李楠.應用高頻超聲顯像診斷急性闌尾炎的臨床價值再探討.中國超聲醫學雜志, 2012, 24(6):69-72.
22. 周楊, 王雪松, 馮曉曦.多層螺旋CT與超聲檢查在急性闌尾炎術前中的應用價值.中國CT和MRI雜志, 2016, 14(2):118-120.
23. 石尖兵, 王凌, 歐華林, 等.超聲與CT在急性闌尾炎臨床應用中的對比研究.中華臨床醫師雜志:電子版, 2010, 4(2):211-214.
24. 王振芳, 岳學旺, 畢言剛, 等.急性闌尾炎超聲與64排螺旋CT檢查對比分析.實用放射學雜志, 2014, 30(7):1154-1156.
25. 張彥彩, 朱小忠.螺旋CT低劑量掃描研究進展.中國醫學影像技術, 2010, 26(7):1376-1378.
26. 劉彬, 喬磊, 白玫. CT低劑量技術新進展.中國醫學裝備, 2012, 9(8):48-51.

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

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