Multi-slice Spiral CT To Estimate The Severity Of Acute Appendicitis

PART ? Index of diagnosis to Estimate of the Severity of Acute AppendicitisObjective:To analyze the diagnosis value of clinical manifestations,laboratory examination results and MSCT signs of acute appendicitis in different pathological types.Methods:We retrospectively reviewed the database from January 1,2016 to March 31,2018 about 308 patients who had been operated and pathologically proven of acute appendicitis in Yantai Affiliated Hospital of Binzhou Medical University Clinical data of the patient group were collected in the in the patient medical records system,such as age,sex,clinical symptoms and signs,number of white blood cells and proportion of neutrophils,the time from CT examination to operation,etc.CT imaging data of the patients group and control group were collected in the PACS system.MPR and CPR by the Siemens reconstruction system were performed on the appendices of the two groups to display the full appendix to enrolled the Location of the appendix,the largest diameter and maximum appendiceal wall thickness,the collection of appendicitis concurrent signs,such as appendicolith,periappendiceal fluid collection,pelvic effusion,extraluminal air,coexisting lesions,etc.With SPSS software,the above clinical and imaging data were analyzed the differences between the patients group.ResultsNausea and vomiting of clinical symptoms to appendicitis were significant differences between the each patient group(?2=21.766,P=0.001).The above differences between the three groups were statistically significant,especially the proportion of neutrophils(F=11.075,P=0.001).The appendicolith could be seen in all three groups,no significant statistical difference.Periappendiceal fluid,surrounding intestine swelling and pelvic effusion were more common in the purulent appendicitis and gangrene appendicitis,while extraluminal air only seen in gangrenous appendicitis(7/21).Such as T?37.5?,the count of WBC?10 x10^9,the proportion of neutrophils?70%,the appendix maximum thickness?6 mm,the wall of the appendix?2 mm,these as the index to estimate the severity of appendicitis was no statistically significant difference between the patients groups.Conclusion:Clinical manifestations cannot distinguish the different pathological types of acute appendicitis.The proportion of neutrophil has certain value to differentiate appendicitis type.Excepted extraluminal air,no MSCT signs in this study could distinguish different types of acute appendicitis.Common clinical manifestations,laboratory findings,and MSCT signs did not estimate the severity of appendicitis.PART ? CT value of Periappendiceal Fat Stranding in the diagnosis and Severity Assessment of Acute AppendicitisObjective:CT value of periappendiceal fat stranding in patients with acute appendicitis and normal people were studied to analyze the activity in the differential diagnosis of normal appendix and acute appendicitis of various pathological types,so as to guide clinical selection of reasonable treatment programs.Methods:We retrospectively reviewed the database from January 1,2016 to March 31,2018 about 308 patients who had been operated and pathologically proven of acute appendicitis and 243 control person in Yantai Affiliated Hospital of Binzhou Medical University.CT imaging data of the patients group and control group were collected in the PACS system.MPR and CPR by the Siemens reconstruction system were performed on the appendices of the two groups to display the full appendix.Measured the CT value of seven position,they were periappendiceal fat(CTa),mesenteric fat gap(CTm),abdominal anterior wall subcutaneous fat(CTaw),abdominal posterior wall subcutaneous fat(CTpw),retroperitoneal fat(CTrp),pygal subcutaneous fat(CTpy)and psoas major muscle(CTps).The absolute value of CT value of periappendiceal fat/CT value of the other six groups was further calculated.With SPSS software,to compare the CT values of different sites between the patients group and the control group,as well as the absolute value of CT values of periappendiceal fat/other six groups.Results:CT value of periappendiceal fat were significantly different between the control group and the patients group(F=489.138,P=0.001),this was similar to mesenteric fat gap(CTm)abdominal anterior wall subcutaneous fat(CTaw),abdominal posterior wall subcutaneous fat(CTpw),retroperitoneal fat(CTrp).The CT values of pygal subcutaneous fat(F=0.918,P=0.338)and psoas major muscle(F=1.138,P=0.287)showed no significant difference between the two groups.We used the absolute value of CT value of periappendiceal fat/CT value of psoas major muscle as the pathological classification of acute appendicitis,and obtained the optimal boundary value of each group:1.603 for the control group(AUC:0.891,95%CI:0.864?0.918,The sensitivity and specificity were 94.6%and 71.4%),simple gtoup were 0.449(AUC:0.531,95%CI:0.462?0.600,The sensitivity and specificity were 91.5%and 20.8%),pyogenic group were 0.623(AUC:0.845,95%CI:0.711?0.878,The sensitivity and specificity were 76.3%and 81.7%)and gangrene group was 0.692(AUC:0.763,95%CI:0.670?0.855,The sensitivity and specificity were 85.7%and 67.7%),respectively.In addition to the small AUC in the simple group,the other three groups was between 0.763?0.891,indicating that the ratio of CT values in this group had a good diagnostic efficiency.Conclusion:CT value changes caused by periappendiceal fat stranding can be used as a quantitative auxiliary index in the diagnosis of acute appendicitis.The absolute ratio of CT value of periappendiceal fat to that of psoas major muscle can not only serve as a quantitative auxiliary index for the diagnosis of acute appendicitis,but also help to estimate the pathological type of patients with appendicitis,so as to guide clinical selection of a reasonable treatment plan.