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The efficacy of nonenhanced computed tomography in the diagnosis of acute appendicitis

Yıl 2018, Cilt: 10 Sayı: 2, 119 - 124, 01.12.2018
https://doi.org/10.21601/ortadogutipdergisi.407830

Öz

Aim: To compare the effectiveness of contrast-enhanced (CCT) and nonenhanced computed tomography (NECT) in the diagnosis of acute appendicitis.

Material and Method: Patients’ reported to have acute appendicitis on abdominal computed tomography (CT) between January 2017 and February 2018 were identified from the radiology database.The images and clinical characteristics of 149 consecutive identified patients (male/female=88/61) were evaluated. The specific CT findings of acute appendicitis were recorded separately for NECT and CCT images by one radiologists without knowledge of the identity and final diagnosis of the patients. The sensitivity, specificity, positive and negative predictive values, and accuracy of CT diagnosis for acute appendicitis were compared to the clinical and surgical findings.

Results: Eighty-one (54.4%) of the 149 patients (males/females=48/33,age range:18–74 years; mean age:33.6 years) were acute appendicitis. There was no significant difference in mean age, appendiceal diameter, and presenting appendicolith between males and females in NECT and CCT groups (p ranged from 0.113 to 1). Sensitivity, specificity, positive and negative predictive values and accuracy for the diagnosis of acute appendicitis were 97.9%, 94.6%, 95.9% and 97.2%, 96.5%, respectively in patients with NECT; 96.9%, 95.8%, 96.9%, and 95.8%, %96.4, respectively in patients with CCT.







Conclusion: The diagnostic sensitivity, specificity, and accuracy of NECT are similar to CCT for the diagnosis of acute appendicitis. NECT has several advantages for patients with suspected appendicitis in a busy emergency department setting.

Kaynakça

  • 1. Anderson BA, Salem L, Flum DR. A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. The American journal of surgery. 2005;190:474-8.
  • 2. Żyluk A, Ostrowski P. An analysis of factors influencing accuracy of the diagnosis of acute appendicitis. Polish Journal of Surgery. 2011;83:135-43.
  • 3. Lin K, Leung W, Wang C, Chen W. Cost analysis of management in acute appendicitis with CT scanning under a hospital global budgeting scheme. Emergency Medicine Journal. 2008;25:149-52.
  • 4. Pickhardt PJ, Lawrence EM, Pooler BD, Bruce RJ. Diagnostic performance of multidetector computed tomography for suspected acute appendicitis. Annals of internal medicine. 2011;154:789-96.
  • 5. Kim K, Lee CC, Song K-J, Kim W, Suh G, Singer AJ. The impact of helical computed tomography on the negative appendectomy rate: a multi-center comparison. Journal of Emergency Medicine. 2008;34:3-6.
  • 6. Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Annals of emergency medicine. 2010;55:51-9.
  • 7. Tamburrini S, Brunetti A, Brown M, Sirlin C, Casola G. Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings. European radiology. 2007;17:2055-61.
  • 8. Shin LK, Jeffrey RB. Sonography and computed tomography of the mimics of appendicitis. Ultrasound quarterly. 2010;26:201-10.
  • 9. Karam A, Birjawi G, Sidani C, Haddad MC. Alternative diagnoses of acute appendicitis on helical CT with intravenous and rectal contrast. Clinical imaging. 2007; 31:77-86.
  • 10. Hill BC, Johnson SC, Owens EK, Gerber JL, Senagore AJ. CT scan for suspected acute abdominal process: impact of combinations of IV, oral, and rectal contrast. World journal of surgery. 2010;34:699-703.
  • 11. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, Lawrason JN, McCabe CJ. Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. AJR. American journal of roentgenology. 1997;169:1275-80.
  • 12. Rao PM, Rhea JT, Novelline RA. Distal appendicitis: CT appearance and diagnosis. Radiology. 1997;204:709-12.
  • 13. Funaki B, Grosskreutz S, Funaki C. Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR. American journal of roentgenology. 1998;171:997-1001.
  • 14. Chiu Y-H, Chen J-D, Wang S-H, et al. Whether intravenous contrast is necessary for CT diagnosis of acute appendicitis in adult ED patients? Academic radiology. 2013;20:73-8.
  • 15. Funaki B. Nonenhanced CT for suspected appendicitis. Radiology. 2000;216:916-8.
  • 16. Anderson SW, Soto JA, Lucey BC, et al. Abdominal 64-MDCT for suspected appendicitis: the use of oral and IV contrast material versus IV contrast material only. American Journal of Roentgenology. 2009;193:1282-8.
  • 17. Rao PM, Rhea JT, Novelline RA. Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. Journal of computer assisted tomography. 1997;21:686-92.
  • 18. Pereira JM, Sirlin CB, Pinto PS, Jeffrey RB, Stella DL, Casola G. Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics. 2004;24:703-15.
  • 19. Balthazar EJ, Megibow AJ, Gordon RB, Whelan CA, Hulnick D. Computed tomography of the abnormal appendix. Journal of computer assisted tomography. 1988; 12:595-601.

Akut apandisit tanısında kontrastsız bilgisayarlı tomografinin etkinliği

Yıl 2018, Cilt: 10 Sayı: 2, 119 - 124, 01.12.2018
https://doi.org/10.21601/ortadogutipdergisi.407830

Öz

Amaç: Akut apandisit tanısının
konulmasında intravenöz kontrast madde kullanılarak ve kullanılmadan elde
edilen bilgisayarlı tomografi incelemelerinin etkinliğini karşılaştırmaktır.

Gereç
ve Yöntem: 1
Ocak 2017 ile 1 Şubat 2018 tarihleri arasında, acil servise akut nontravmatik
karın ağrısı ile başvuran, akut apandisitit ön tanısı ile bilgisayarlı
tomografi incelemesi yapılan, 18 yaş üstü hastaların medikal kayıtları ve
görüntüleme bulguları retrospektif değerlendirildi. Çalışmaya 149 hasta
(erkek/kadın=88/61) dahil edildi. Bilgisayarlı tomografi görüntüleri,
hastaların daha önceki bilgisayarlı tomografi raporunu ve nihai tanısını
bilmeyen bir radyolog tarafından
değerlendirildi. Akut apandisit tanısında kontrastsız ve kontrastlı
bilgisayarlı tomografinin duyarlılığı, özgüllüğü, pozitif ve negatif tahmini
değeri, doğruluğu analiz edildi.

Bulgular: Bilgisayarlı tomografide 81/149
hasta (erkek/kadın=48/33, yaşları 18–74
arasında; ortalama yaş 33,6)
akut
apandisit olarak değerlendirildi. Kontrastsız ve kontrastlı bilgisayarlı
tomografi  ile akut apandisit tanısı
konulan erkekler ile kadınlar arasında, yaş, apendiksin çapı, apendikolit
görülmesi bakımından anlamlı farklılık saptanmadı (p>0,05). Cerrahi sonuçlarına ve hastaların klinik takiplere göre
kontrastsız ve kontrastlı bilgisayarlı tomografinin akut apandisit tanısı
koymada duyarlılığı, özgüllüğü, pozitif ve negatif tahmini değeri, doğruluk
oranı sırasıyla: %97,9, %94,6%, %95,9 ve %97,2, %96,5 ; %96,9, %95,8, %96,9 ve %95,8, %96,4 bulundu.







Sonuçlar: Akut apandisitin tanısında
kontrastsız bilgisayarlı tomografinin, kontrastlı bilgisayarlı tomografi kadar
tanısal doğruluğu ve duyarlılığı bulunmaktadır. Hasta yoğunluğunun fazla olduğu
acil servislerde kontrast madde kullanılmadan da akut apandisit tanısı
koyulabilir.  

Kaynakça

  • 1. Anderson BA, Salem L, Flum DR. A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. The American journal of surgery. 2005;190:474-8.
  • 2. Żyluk A, Ostrowski P. An analysis of factors influencing accuracy of the diagnosis of acute appendicitis. Polish Journal of Surgery. 2011;83:135-43.
  • 3. Lin K, Leung W, Wang C, Chen W. Cost analysis of management in acute appendicitis with CT scanning under a hospital global budgeting scheme. Emergency Medicine Journal. 2008;25:149-52.
  • 4. Pickhardt PJ, Lawrence EM, Pooler BD, Bruce RJ. Diagnostic performance of multidetector computed tomography for suspected acute appendicitis. Annals of internal medicine. 2011;154:789-96.
  • 5. Kim K, Lee CC, Song K-J, Kim W, Suh G, Singer AJ. The impact of helical computed tomography on the negative appendectomy rate: a multi-center comparison. Journal of Emergency Medicine. 2008;34:3-6.
  • 6. Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Annals of emergency medicine. 2010;55:51-9.
  • 7. Tamburrini S, Brunetti A, Brown M, Sirlin C, Casola G. Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings. European radiology. 2007;17:2055-61.
  • 8. Shin LK, Jeffrey RB. Sonography and computed tomography of the mimics of appendicitis. Ultrasound quarterly. 2010;26:201-10.
  • 9. Karam A, Birjawi G, Sidani C, Haddad MC. Alternative diagnoses of acute appendicitis on helical CT with intravenous and rectal contrast. Clinical imaging. 2007; 31:77-86.
  • 10. Hill BC, Johnson SC, Owens EK, Gerber JL, Senagore AJ. CT scan for suspected acute abdominal process: impact of combinations of IV, oral, and rectal contrast. World journal of surgery. 2010;34:699-703.
  • 11. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, Lawrason JN, McCabe CJ. Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. AJR. American journal of roentgenology. 1997;169:1275-80.
  • 12. Rao PM, Rhea JT, Novelline RA. Distal appendicitis: CT appearance and diagnosis. Radiology. 1997;204:709-12.
  • 13. Funaki B, Grosskreutz S, Funaki C. Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR. American journal of roentgenology. 1998;171:997-1001.
  • 14. Chiu Y-H, Chen J-D, Wang S-H, et al. Whether intravenous contrast is necessary for CT diagnosis of acute appendicitis in adult ED patients? Academic radiology. 2013;20:73-8.
  • 15. Funaki B. Nonenhanced CT for suspected appendicitis. Radiology. 2000;216:916-8.
  • 16. Anderson SW, Soto JA, Lucey BC, et al. Abdominal 64-MDCT for suspected appendicitis: the use of oral and IV contrast material versus IV contrast material only. American Journal of Roentgenology. 2009;193:1282-8.
  • 17. Rao PM, Rhea JT, Novelline RA. Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. Journal of computer assisted tomography. 1997;21:686-92.
  • 18. Pereira JM, Sirlin CB, Pinto PS, Jeffrey RB, Stella DL, Casola G. Disproportionate fat stranding: a helpful CT sign in patients with acute abdominal pain. Radiographics. 2004;24:703-15.
  • 19. Balthazar EJ, Megibow AJ, Gordon RB, Whelan CA, Hulnick D. Computed tomography of the abnormal appendix. Journal of computer assisted tomography. 1988; 12:595-601.
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Araştırma makaleleri
Yazarlar

Serra Özbal Güneş 0000-0003-1019-9925

Yeliz Aktürk

Kerim Bora Yılmaz Bu kişi benim

Yayımlanma Tarihi 1 Aralık 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 10 Sayı: 2

Kaynak Göster

Vancouver Özbal Güneş S, Aktürk Y, Yılmaz KB. Akut apandisit tanısında kontrastsız bilgisayarlı tomografinin etkinliği. otd. 2018;10(2):119-24.

e-ISSN: 2548-0251

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