Taylor George A, Callahan Michael J, Rodriguez Diana, Smink Douglas S
Department of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, MA, USA.
Pediatr Radiol. 2006 Apr;36(4):331-7. doi: 10.1007/s00247-005-0079-9. Epub 2006 Feb 7.
Mistakes have been made by the use of CT in diagnosing children with suspected appendicitis. Although others have reported the frequency of diagnostic errors, we were unable to find any studies that addressed the specific situations in which diagnostic errors occurred in children with suspected appendicitis.
To investigate the frequency and type of diagnostic errors resulting from CT of children with suspected appendicitis when compared to surgical and pathological diagnosis.
We reviewed imaging, clinical and pathological data on 1,207 consecutive pediatric patients who underwent CT examination for suspected appendicitis. Imaging findings were categorized as false-positive, false-negative, or indeterminate. Errors were classified as interpretative, technical or unavoidable. Concordance between surgical and pathological findings was also evaluated.
The imaging findings of 34 patients (2.8%) were discrepant with the pathological examination or clinical follow-up. The errors in 23 cases were classified as interpretive (68%) and 11 as unavoidable (32%), and no errors were classified as technical. There were 23 false-positive errors (68%), 6 false-negative errors (18%), and 5 indeterminate imaging studies (15%). Isolated CT findings of an enlarged (greater than 6 mm) appendix, fat stranding, thickened bowel or non-visualization of the distal appendix were the most common false-positive CT findings. Of these 34 patients, 22 underwent appendectomy, with 10 (45%) having discordant surgical and pathological findings.
Isolated CT findings of an appendicolith, an enlarged appendix, or minimal fat stranding are not sufficient signs for the diagnosis of appendicitis. Pathological diagnosis rather than surgical findings should be used as the reference standard of true-positive imaging findings.
在使用CT诊断疑似阑尾炎的儿童时出现了一些错误。尽管其他人报告了诊断错误的频率，但我们未能找到任何针对疑似阑尾炎儿童诊断错误发生的具体情况的研究。
与手术和病理诊断相比，调查疑似阑尾炎儿童CT诊断错误的频率和类型。
我们回顾了1207例因疑似阑尾炎接受CT检查的连续儿科患者的影像、临床和病理数据。影像表现分为假阳性、假阴性或不确定。错误分为解释性、技术性或不可避免性。还评估了手术和病理结果之间的一致性。
34例患者（2.8%）的影像表现与病理检查或临床随访结果不一致。23例错误被分类为解释性（68%），11例为不可避免性（32%），没有错误被分类为技术性。有23例假阳性错误（68%），6例假阴性错误（18%），5例影像检查结果不确定（15%）。孤立的CT表现为阑尾增大（大于6mm）、脂肪条索征、肠壁增厚或阑尾远端未显影是最常见的CT假阳性表现。在这34例患者中，22例接受了阑尾切除术，其中10例（45%）手术和病理结果不一致。
孤立的阑尾结石、阑尾增大或轻微脂肪条索征的CT表现不足以诊断阑尾炎。病理诊断而非手术结果应用作真正阳性影像表现的参考标准。
