多层螺旋CT对继发性附件扭转的综合评估

目的探讨继发性附件扭转的CT特征及其诊断效能,构建继发性附件扭转的评分系统。资料与方法收集经手术证实的伴有附件肿物的继发性附件扭转患者37例,以及伴有腹痛、附件肿物的对照组患者34例,分析继发性附件扭转的CT特征,采用受试者工作特征(ROC)曲线评价其诊断效能,构建继发性附件扭转的综合评分系统(AT-CI)。结果与对照组比较,继发性附件扭转以下CT特征发生率较高,包括肿物壁偏心性增厚(X^2=4.41,P<0.05)、附件出血(X^2=12.68,P<0.001)、肿物-子宫之间团块状结构(X^2=13.62,P<0.001)、旋涡征(X^2=10.71,P<0.05)、附件周围脂肪模糊/腹水(X^2=5.82,P<0.05)。其中肿物-子宫之间团块状结构敏感度及诊断价值最高,为81.1%(ROC曲线下面积0.71),旋涡征特异度最高,为91.2%。ATCI诊断效能优于任意单一CT特征(ROC曲线下面积0.83),评分0~2分继发性附件扭转可能性小,3~4分怀疑继发性附件扭转,评分>4分,则高度怀疑继发性附件扭转且特异度为100%。结论继发性附件扭转具有典型的CT特征,包括肿物壁偏心性增厚、附件出血、肿物-子宫之间团块状结构、旋涡征、肿物周围脂肪模糊/腹水。AT-CI是综合了继发性附件扭转全部CT特征的实用评分系统,提高了继发性附件扭转的诊断准确性。

Multi-Slice Spiral CT for Comprehensive Evaluation of Secondary Adnexal Torsion

Purpose To explore the CT features and diagnostic efficacy of secondary adnexal torsion,and to establish a scoring system for secondary adnexal torsion.Materials and Methods A total of 37 patients with second adnexal torsion proven by surgeries and 34 control patients admitted for abdominal pain and presenting with an adnexal mass were enrolled in this study,CT findings of all second adnexal torsion were analyzed,the diagnostic efficiency was evaluated by ROC curve,and the adnexal torsion-compositive index(AT-CI)was built.Results Compared with control group,the incidence of CT features of secondary adnexal torsion was higher,including asymmetric wall thickening of the mass(X^2=4.41,P<0.05),adnexal hemorrhage(X^2=12.68,P<0.001),inter-utero-ovarian mass(X^2=13.62,P<0.001),whirlpool sign(X^2=10.71,P<0.05)and ascites(X^2=5.82,P<0.05).The inter-utero-ovarian mass had the highest sensitivity and diagnostic value(81.1%,ROC=0.71),the whirlpool sign had the highest specificity(91.2%).The AT-CI was more accurate than any CT feature in predicting secondary adnexal torsion(ROC=0.83).There was the lowest risk of AT with AT-CI score 0-2,patients with modest risk if score 3-4 and there was the highest risk and 100%specificity if score>4.Conclusion Secondary adnexal torsion has typical CT features,including asymmetric wall thickening of the mass,adnexal hemorrhage,inter-utero-ovarian mass,whirlpool sign and ascites.ATCI is a practical scoring system combing all the findings to more accurately diagnose adnexal torsion.