経静脈的造影CTが診断に不要な急性虫垂炎症例の検討
はじめに: 急性虫垂炎の診断にCTを用いることで診断はより確定的になり, 経静脈的造影CT(intravenous contrast-enhanced CT; 以下, IV-CTと略記)は汎用されるようになってきた.本研究の目的は, IV-CTの適応を明らかにし, 不要なIV-CTを削減することである. 適応について, 発症から初診までの時間を加味して検討した. 方法: IV-CTは, 右下腹部痛を有する症例あるいは自発痛がなくても理学検査所見を右下腹部に認める症例に対して行った. 理学検査所見が詳細に記録され, 初診時に血液検査およびIV-CTを施行し, 検により(1)半日未満(半日群),...
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Published in | 日本消化器外科学会雑誌 Vol. 40; no. 1; pp. 8 - 14 |
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Main Authors | , , , , |
Format | Journal Article |
Language | Japanese |
Published |
一般社団法人 日本消化器外科学会
2007
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Online Access | Get full text |
ISSN | 0386-9768 1348-9372 |
DOI | 10.5833/jjgs.40.8 |
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Abstract | はじめに: 急性虫垂炎の診断にCTを用いることで診断はより確定的になり, 経静脈的造影CT(intravenous contrast-enhanced CT; 以下, IV-CTと略記)は汎用されるようになってきた.本研究の目的は, IV-CTの適応を明らかにし, 不要なIV-CTを削減することである. 適応について, 発症から初診までの時間を加味して検討した. 方法: IV-CTは, 右下腹部痛を有する症例あるいは自発痛がなくても理学検査所見を右下腹部に認める症例に対して行った. 理学検査所見が詳細に記録され, 初診時に血液検査およびIV-CTを施行し, 検により(1)半日未満(半日群), (2)半日以上1日未満(単日群), (3)1日以上(複日群)の3群に分け, Blumberg徴候, 筋性防御の有無, 体温, 白血球数, 査後24時間以内に虫垂切除術を行った連続した171例を対象とした. 発症からの時間CRP値を解析した. IV-CT所見においては虫垂腫大の有無と, 虫垂腫大を含む5項目(虫垂腫大・糞石・腹腔内の液体貯留・盲腸または上行結腸の全周性肥厚・小腸麻痺像)の陽性所見数を解析した. 結果: III筋性防御の陽性率は単日群と複日群の虫垂炎症例で有意に高かった. IV-CT上の虫垂腫大は各群内の虫垂炎症例で有意に認めた. IV-CTの陽性所見は複日群で有意に多く認めた. その他の項目は, 各群内において有意差を認めなかった.考察: 発症から初診まで半日以上経過し筋性防御を認めた場合, 虫垂炎である確率が高くIVCTを省略できる可能性が示唆された. |
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AbstractList | はじめに: 急性虫垂炎の診断にCTを用いることで診断はより確定的になり, 経静脈的造影CT(intravenous contrast-enhanced CT; 以下, IV-CTと略記)は汎用されるようになってきた.本研究の目的は, IV-CTの適応を明らかにし, 不要なIV-CTを削減することである. 適応について, 発症から初診までの時間を加味して検討した. 方法: IV-CTは, 右下腹部痛を有する症例あるいは自発痛がなくても理学検査所見を右下腹部に認める症例に対して行った. 理学検査所見が詳細に記録され, 初診時に血液検査およびIV-CTを施行し, 検により(1)半日未満(半日群), (2)半日以上1日未満(単日群), (3)1日以上(複日群)の3群に分け, Blumberg徴候, 筋性防御の有無, 体温, 白血球数, 査後24時間以内に虫垂切除術を行った連続した171例を対象とした. 発症からの時間CRP値を解析した. IV-CT所見においては虫垂腫大の有無と, 虫垂腫大を含む5項目(虫垂腫大・糞石・腹腔内の液体貯留・盲腸または上行結腸の全周性肥厚・小腸麻痺像)の陽性所見数を解析した. 結果: III筋性防御の陽性率は単日群と複日群の虫垂炎症例で有意に高かった. IV-CT上の虫垂腫大は各群内の虫垂炎症例で有意に認めた. IV-CTの陽性所見は複日群で有意に多く認めた. その他の項目は, 各群内において有意差を認めなかった.考察: 発症から初診まで半日以上経過し筋性防御を認めた場合, 虫垂炎である確率が高くIVCTを省略できる可能性が示唆された. |
Author | 北川, 喜己 佐竹, 立成 河野, 弘 根東, 順子 真弓, 俊彦 |
Author_xml | – sequence: 1 fullname: 河野, 弘 organization: 名古屋掖済会病院外科 – sequence: 1 fullname: 佐竹, 立成 organization: 名古屋掖済会病院病理部 – sequence: 1 fullname: 根東, 順子 organization: 名古屋掖済会病院外科 – sequence: 1 fullname: 北川, 喜己 organization: 名古屋掖済会病院救急科 – sequence: 1 fullname: 真弓, 俊彦 organization: 名古屋大学大学院医学系研究科救急集中治療医学 |
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References | 24) Mori Y, Yamasaki M, Furukawa A et al: Enhanced CT in the diagnosis of acute appendicitis to evaluate the severity of disease: comparison of CT findings and histological diagnosis. Radiat Med 19: 197-202, 2001 25) Choi YH, Fischer E, Hoda SA et al: Appendiceal CT in 140 cases. Diagnostic criteria for acute and necrotizing appendicitis. Clin Imaging 22: 252-271, 1998 14) Mun S, Ernst RD, Chen K et al: Rapid CT diagnosis of acute appendicitis with IV contrast material.Emerg Radiol 12: 99-102, 2006 18) Naffaa LN, Ishak GE, Haddad MC: The value of contrast-enhanced helical CT scan with rectal contrast enema in the diagnosis of acute appendicitis.Clin Imaging 29: 255-258, 2005 23) Lowe LH, Penney MW, Scheker LE et al: Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis ? Am J Roentgenol 175: 981-984, 2000 7) Wijetunga R, Tan BS, Rouse JC et al: Diagnostic accuracy of focused appendiceal CT in clinically equivocal cases of acute appendicitis. Radiology 221: 747-753, 2001 17) Brandt MM, Wahl WL: Liberal use of CT scanning helps to diagnose appendicitis in adults. Am Surg 69: 727-731, 2003 19) Raptopoulos V, Katsou G, Rosen MP et al: Acute appendicitis: effect of increased use of CT on selecting patients earlier. Radiology 226: 521-526. 11) Iwahashi N, Kitagawa Y, Mayumi T et al: Intravenous contrast-enhanced computed tomography in the diagnosis of acute appendicitis. World J Surg 29: 83-87, 2005 8) Balthazar EJ, Megibow AJ, Siegel SE et al: Appendicitis: prospective evaluation with highresolution CT. Radiology 180: 21-24, 1991 15) Malone AJ Jr, Wolf CR, Malmed AS et al: Diagnosis of acute appendicitis: value of unenhanced CT. Am J Roentgenol 160: 763-766, 1993 22) Rao PM, Rhea JT, Novelline RA: Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 21: 686-692, 1997 5) Harswick C, Uyenishi AA, Kordick MF et al: Clinical guidelines, computed tomography scan, and negative appendectomies: a case series. Am J Emerg Med 24: 68-72, 2006 6) Sivit CJ, Applegate KE, Berlin SC et al: Evaluation of suspected appendicitis in children and young adults: helical CT. Radiology 216: 430-433, 2000 1) Izbicki JR, Knoefel WT, Wilker DK et al: Accurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients. Eur J Surg 158: 227-231, 1992 20) Wakeley CP: The position of the vermiform appendix as ascertained by an analysis of 10,000 cases. J Anat 67: 277-283, 1933 2) Rao PM, Rhea JT, Rattner DW et al: Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 229: 344-349, 1999 12) Kamel IR, Goldberg SN, Keogan MT et al: Right lower quadrant pain and suspected appendicitis: nonfocused appendiceal CT-review of 100 cases. Radiology 217: 159-163, 2000 21) Curtin KR, Fitzgerald SW, Nemcek AA Jr et al: CT diagnosis of acute appendicitis: imaging findings.Am J Roentgenol 164: 905-909, 1995 16) Lane MJ, Liu DM, Huynh MD et al: Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 213: 341-346, 1999 13) Raman SS, Lu DS, Kadel BM et al: Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. Am J Roentgenol 178: 1319-1325, 2002 10) Wise SW, Labuski MR, Kasales CJ et al: Comparative assessment of CT and sonographic techniques for appendiceal imaging. Am J Roentgenol 176: 933-941, 2001 3) Jones K, Pena AA, Dunn EL et al: Are negative appendectomies still acceptable ? Am J Surg 188: 748-754, 2004 4) Rhea JT, Halpern EF, Ptak T et al: The status of appendiceal CT in an urban medical canter 5 years after its introduction: experience with 753 patients. Am J Roentgenol 184: 1802-1808, 2005 9) Rao PM, Rhea JT, Novelline RA et al: Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. Am J Roentgenol 169: 1275-1280, 1997 |
References_xml | – reference: 4) Rhea JT, Halpern EF, Ptak T et al: The status of appendiceal CT in an urban medical canter 5 years after its introduction: experience with 753 patients. Am J Roentgenol 184: 1802-1808, 2005 – reference: 17) Brandt MM, Wahl WL: Liberal use of CT scanning helps to diagnose appendicitis in adults. Am Surg 69: 727-731, 2003 – reference: 10) Wise SW, Labuski MR, Kasales CJ et al: Comparative assessment of CT and sonographic techniques for appendiceal imaging. Am J Roentgenol 176: 933-941, 2001 – reference: 6) Sivit CJ, Applegate KE, Berlin SC et al: Evaluation of suspected appendicitis in children and young adults: helical CT. Radiology 216: 430-433, 2000 – reference: 11) Iwahashi N, Kitagawa Y, Mayumi T et al: Intravenous contrast-enhanced computed tomography in the diagnosis of acute appendicitis. World J Surg 29: 83-87, 2005 – reference: 24) Mori Y, Yamasaki M, Furukawa A et al: Enhanced CT in the diagnosis of acute appendicitis to evaluate the severity of disease: comparison of CT findings and histological diagnosis. Radiat Med 19: 197-202, 2001 – reference: 21) Curtin KR, Fitzgerald SW, Nemcek AA Jr et al: CT diagnosis of acute appendicitis: imaging findings.Am J Roentgenol 164: 905-909, 1995 – reference: 12) Kamel IR, Goldberg SN, Keogan MT et al: Right lower quadrant pain and suspected appendicitis: nonfocused appendiceal CT-review of 100 cases. Radiology 217: 159-163, 2000 – reference: 5) Harswick C, Uyenishi AA, Kordick MF et al: Clinical guidelines, computed tomography scan, and negative appendectomies: a case series. Am J Emerg Med 24: 68-72, 2006 – reference: 8) Balthazar EJ, Megibow AJ, Siegel SE et al: Appendicitis: prospective evaluation with highresolution CT. Radiology 180: 21-24, 1991 – reference: 7) Wijetunga R, Tan BS, Rouse JC et al: Diagnostic accuracy of focused appendiceal CT in clinically equivocal cases of acute appendicitis. Radiology 221: 747-753, 2001 – reference: 2) Rao PM, Rhea JT, Rattner DW et al: Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 229: 344-349, 1999 – reference: 23) Lowe LH, Penney MW, Scheker LE et al: Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis ? Am J Roentgenol 175: 981-984, 2000 – reference: 20) Wakeley CP: The position of the vermiform appendix as ascertained by an analysis of 10,000 cases. J Anat 67: 277-283, 1933 – reference: 3) Jones K, Pena AA, Dunn EL et al: Are negative appendectomies still acceptable ? Am J Surg 188: 748-754, 2004 – reference: 1) Izbicki JR, Knoefel WT, Wilker DK et al: Accurate diagnosis of acute appendicitis: a retrospective and prospective analysis of 686 patients. Eur J Surg 158: 227-231, 1992 – reference: 22) Rao PM, Rhea JT, Novelline RA: Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 21: 686-692, 1997 – reference: 18) Naffaa LN, Ishak GE, Haddad MC: The value of contrast-enhanced helical CT scan with rectal contrast enema in the diagnosis of acute appendicitis.Clin Imaging 29: 255-258, 2005 – reference: 15) Malone AJ Jr, Wolf CR, Malmed AS et al: Diagnosis of acute appendicitis: value of unenhanced CT. Am J Roentgenol 160: 763-766, 1993 – reference: 25) Choi YH, Fischer E, Hoda SA et al: Appendiceal CT in 140 cases. Diagnostic criteria for acute and necrotizing appendicitis. Clin Imaging 22: 252-271, 1998 – reference: 13) Raman SS, Lu DS, Kadel BM et al: Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. Am J Roentgenol 178: 1319-1325, 2002 – reference: 19) Raptopoulos V, Katsou G, Rosen MP et al: Acute appendicitis: effect of increased use of CT on selecting patients earlier. Radiology 226: 521-526. – reference: 9) Rao PM, Rhea JT, Novelline RA et al: Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. Am J Roentgenol 169: 1275-1280, 1997 – reference: 16) Lane MJ, Liu DM, Huynh MD et al: Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 213: 341-346, 1999 – reference: 14) Mun S, Ernst RD, Chen K et al: Rapid CT diagnosis of acute appendicitis with IV contrast material.Emerg Radiol 12: 99-102, 2006 |
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Snippet | はじめに: 急性虫垂炎の診断にCTを用いることで診断はより確定的になり, 経静脈的造影CT(intravenous contrast-enhanced CT; 以下, IV-CTと略記)は汎... |
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Title | 経静脈的造影CTが診断に不要な急性虫垂炎症例の検討 |
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