Teo E L, Tan K P, Lam S L, Ong C L, Wong C S
Department of Diagnostic Imaging, Paediatric Surgery, Kandang Kerbau Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899.
Singapore Med J. 2000 Aug;41(8):387-92.
To evaluate the roles and effectiveness of US and CT in a clinical algorithm for the evaluation of children with suspected appendicitis.
Patients with suspected appendicitis were prospectively evaluated with ultrasound (US), and in some cases with CT, after they were graded to have high, intermediate or low clinical likelihood for appendicitis. Imaging findings were made known to clinicians who then decided on a line of management. Patho-histological examination and clinical follow-up established the final diagnoses, which were correlated with the imaging findings. The effect of imaging on the management of patients was examined.
Overall, the sensitivity of US was 92.9%, specificity 96.9%, accuracy 96.0%, positive predictive value 89.7% and negative predictive value 97.9%. Imaging did not affect the decision to operate in 13/14 (92.9%) patients in the high likelihood subgroup. Imaging guided the clinicians to the right management pathway in 26/30 (86.7%) patients in the intermediate group. 77/82 (93.9%) of US was truly negative in the low likelihood group. CT was performed in 12 patients because of unsatisfactory US scans or incompatibility between the US and the clinical findings. CT correctly diagnosed the presence or absence of appendicitis in all 12 patients.
US and CT are accurate modalities in the diagnosis of acute appendicitis in children. US is most useful in patients with equivocal clinical findings. US should be the first modality used to evaluate children with suspected appendicitis. CT should be reserved for cases where US is sub-optimal or where the findings are inconsistent with the clinical findings.
评估超声（US）和计算机断层扫描（CT）在疑似阑尾炎儿童评估临床算法中的作用及有效性。
对疑似阑尾炎患者在根据临床阑尾炎可能性分为高、中、低等级后，前瞻性地进行超声检查，部分病例进行CT检查。将影像学检查结果告知临床医生，然后由其决定治疗方案。通过病理组织学检查和临床随访确定最终诊断，并将其与影像学检查结果进行对比。研究影像学检查对患者治疗的影响。
总体而言，超声的敏感性为92.9%，特异性为96.9%，准确性为96.0%，阳性预测值为89.7%，阴性预测值为97.9%。在高可能性亚组的14例患者中，有13例（92.9%）影像学检查未影响手术决策。在中等可能性组的30例患者中，有26例（86.7%）影像学检查引导临床医生走上正确的治疗途径。在低可能性组中，82例中有77例（93.9%）超声检查结果为真正阴性。因超声扫描结果不理想或超声与临床检查结果不相符，对12例患者进行了CT检查。CT对所有12例患者阑尾炎的存在与否均做出了正确诊断。
超声和CT是诊断儿童急性阑尾炎的准确方法。超声对临床表现不明确的患者最为有用。超声应作为评估疑似阑尾炎儿童的首选检查方法。CT应保留用于超声检查效果欠佳或检查结果与临床检查结果不一致的病例。
