摘要
目的探讨多参数磁共振成像(MRI)对儿童急性阑尾炎的临床诊断价值。方法回顾性分析68例疑似急性阑尾炎的腹痛患儿的临床资料,均行多参数MRI检查,分析多参数MRI诊断急性阑尾炎的敏感性、特异性、漏诊率、误诊率、约登指数及急性阑尾炎患儿的影像表现。结果68例疑似急性阑尾炎患儿中,27例患儿经多参数MRI影像分析诊断为急性阑尾炎,其中经临床复查及手术证实26例为急性阑尾炎,仅1例右侧结肠炎的影像表现被误诊为急性阑尾炎;41例患儿多参数MRI阑尾炎征象阴性患儿均经临床证实。多参数MRI对急性阑尾炎的诊断敏感性为100%(26/26)、特异性为97.6%(41/42)、漏诊率为0、误诊率为2.4%(1/42)、约登指数为0.976。多参数MRI扫描时间约为10~15 min。26例急性阑尾炎患儿的多参数MRI主要影像表现有:阑尾肿大增粗≥7 mm(23例)、阑尾腔内积脓扩散加权成像(DWI)(b=800)呈高信号(26例),在表观弥散系数(ADC)上为低信号,周围脂肪间隙水肿(18例),部分肿大阑尾腔内见T2WI低信号粪石(6例),邻近可见肿大淋巴结(11例),甚至可合并腹腔积液(7例)、小肠梗阻(5例)。结论多参数MRI尤其是DWI(b=800)对于儿童急性阑尾炎具有较高的敏感性和特异性,可以为儿童儿外科手术方式提供准确的信息,从而更好地指导临床治疗和手术方案的制定。
Objective To discuss the clinical value of multi-parameter magnetic resonance imaging(MRI)in children with acute appendicitis.Methods The clinical data of 68 children with abdominal pain suspected of acute appendicitis were retrospectively analyzed.The sensitivity,specificity,missed diagnosis rate,misdiagnosis rate,Youden's index and image manifestations of acute appendicitis were analyzed by multi-parameter MRI.Results Among 68 children with suspected acute appendicitis,27 cases were diagnosed by multi-parameter MRI image analysis,among which 26 cases were confirmed as acute appendicitis by clinical review and surgery,and only 1 case was wrongly diagnosed as acute appendicitis by image manifestations of right colitis.All 41 patients with negative signs of appendicitis with multi-parameter MRI were clinically confirmed.The diagnostic sensitivity of multi-parameter MRI for acute appendicitis was 100%(26/26),the specificity was 97.6%(41/42),the missed diagnosis rate was 0,the misdiagnosis rate was 2.4%(1/42),and the Youden's index was 0.976.The scanning time of multi-parameter MRI was about 10-15 min.The main multi-parameter MRI findings of 26 children with acute appendicitis were as follows:enlarged and thickened appendix≥7 mm(23 cases),high signal on diffusion weighted imaging(DWI)(26 cases)of pus accumulation in the appendix cavity(b=800),low signal on the apparent diffusion coefficient(ADC),edema in the surrounding fat spaces(18 cases),T2WI low signal fecal stones in some enlarged appendix cavities(6 cases),and adjacent enlarged lymph nodes(11 cases),and even combined with abdominal fluid accumulation(7 cases)and small intestinal obstruction(5 cases).Conclusion Multi-parameter MRI,especially DWI(b=800),has high sensitivity and specificity for acute appendicitis in children,and can provide accurate information for pediatric surgery,so as to better guide clinical treatment and the formulation of surgical plans.
作者
吴格昇
孙海成
曲林涛
WU Ge-sheng;SUN Hai-cheng;QU Lin-tao(Department of Imaging,Laizhou Maternity and Child Healthcare Hospital,Yantai 261400,China)
出处
《中国实用医药》
2023年第20期74-77,共4页
China Practical Medicine
基金
烟台市科技计划项目(项目编号:2022YD117)
山东省医药卫生科技发展计划项目(项目编号:202109010240)。
关键词
急性阑尾炎
磁共振成像
临床诊断
Acute appendicitis
Magnetic resonance imaging
Clinical diagnosis
