Keyzer Caroline, Zalcman Marc, De Maertelaer Viviane, Coppens Emmanuel, Bali Maria-Antonietta, Gevenois Pierre Alain, Van Gansbeke Daniel
Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, B-1070-Brussels, Belgium.
Radiology. 2005 Aug;236(2):527-34. doi: 10.1148/radiol.2362040984.
To prospectively compare the diagnostic performance of ultrasonography (US) and unenhanced multi-detector row computed tomography (CT) in patients suspected of having acute appendicitis by using surgery or clinical follow-up as the reference standard.
The institutional review board approved the research protocol. Written informed consent was obtained from all patients or, for those who were adolescents, from their parents. Ninety-four patients (59 female and 35 male patients) aged 16-81 years (mean, 38 years) who were suspected of having acute appendicitis underwent both US and unenhanced multi-detector row CT of the entire abdomen. The examinations were performed within 1-2 hours of each other. US and CT images were obtained and prospectively interpreted by a different radiologist from a group of abdominal radiologists or a group of residents and general radiologists. Radiologists proposed an overall diagnosis and an alternative diagnosis. Data from US and CT were compared, and the definite diagnosis was established with surgical findings (n = 40) or results of clinical follow-up (n = 54) as the reference standard. Comparisons were made for each group of radiologists and the patient's age, body mass index (BMI), and sex. Proportion comparisons were made by using the Pearson chi2 test or the Fisher exact test. Continuous variables were compared between groups with the Mann-Whitney U test.
Thirty patients had definite appendicitis. The sensitivity, specificity, positive and negative predictive values, and accuracy were not significantly different between US and CT or between groups of radiologists (P values ranged from .389 to >.99), regardless of the patient's BMI (P values ranged from .073 to >.99). Misclassifications were compared with the definite alternative diagnosis and were not significantly different between US and CT or between groups of radiologists (P = .061-.592), regardless of patient age (P = .875) or sex (P = .151 and >.99 for male and female patients, respectively). The frequency of inconclusive examinations, however, was significantly higher with US than with CT, regardless of radiologist experience (P = .020 and <.001, respectively).
Although the diagnostic performances of US and multi-detector row CT are comparable, more inconclusive images were obtained with US.
以前瞻性方式比较超声（US）和非增强型多排螺旋计算机断层扫描（CT）对疑似急性阑尾炎患者的诊断性能，以手术或临床随访作为参考标准。
机构审查委员会批准了本研究方案。所有患者均签署了书面知情同意书，对于青少年患者，则由其父母签署。94例年龄在16 - 81岁（平均38岁）、疑似急性阑尾炎的患者接受了全腹部的超声和非增强型多排螺旋CT检查。两项检查在彼此间隔1 - 2小时内完成。超声和CT图像由一组腹部放射科医生或一组住院医师及普通放射科医生中的不同放射科医生获取并进行前瞻性解读。放射科医生提出总体诊断和替代诊断。将超声和CT的数据进行比较，并以手术结果（n = 40）或临床随访结果（n = 54）作为参考标准确定明确诊断。对每组放射科医生以及患者的年龄、体重指数（BMI）和性别进行比较。比例比较采用Pearson卡方检验或Fisher精确检验。组间连续变量比较采用Mann - Whitney U检验。
30例患者确诊为阑尾炎。超声和CT之间或不同放射科医生组之间的敏感性、特异性、阳性和阴性预测值以及准确性无显著差异（P值范围为0.389至>0.99），无论患者的BMI如何（P值范围为0.073至>0.99）。将误诊与明确的替代诊断进行比较，超声和CT之间或不同放射科医生组之间无显著差异（P = 0.061 - 0.592），无论患者年龄（P = 0.875）或性别（男性患者P = 0.151，女性患者P = >0.99）。然而，无论放射科医生的经验如何，超声检查结果不确定的频率显著高于CT（P分别为0.020和<0.001）。
虽然超声和多排螺旋CT的诊断性能相当，但超声获得的不确定图像更多。
