Ganguli Suvranu, Raptopoulos Vassilios, Komlos Fabio, Siewert Bettina, Kruskal Jonathan B
Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215, USA.
Radiology. 2006 Oct;241(1):175-80. doi: 10.1148/radiol.2411050191. Epub 2006 Aug 23.
To retrospectively determine the value of the nonvisualized appendix at multidetector computed tomography (CT) in patients with acute right lower quadrant pain in whom appendicitis was a consideration.
Institutional review board approval was obtained for this HIPAA-compliant study, with waiver of informed consent. Records were retrospectively reviewed in patients who presented to the emergency department between April 29 and October 31, 2003, with right lower quadrant pain. Scanning was performed with the same eight-detector row CT scanner by using oral and (unless contraindicated) intravenous contrast agents, and transverse and coronal reformations were obtained. Two radiologists prospectively evaluated all scans at the time of the examination and rendered a consensus opinion. Clinical follow-up of at least 3 months' duration was performed retrospectively for patients whose appendix was not visualized to determine whether appendicitis had developed. Statistical analysis and calculation of percentages with confidence intervals (CIs) were performed.
Of the 400 consecutive patients who underwent multidetector CT, 132 (33.0%) were male and 268 (67.0%) were female. Eighty patients (20.0%) had acute appendicitis and 79 (19.8%) had another cause for abdominal pain. A normal appendix with no other cause for pain was seen in 182 patients (45.5%). In 59 patients (14.8%), the appendix was not visualized. Of these 59 patients, 50 had adequate follow-up. Clinical follow-up was uneventful in 49 of these 50 patients. Thus, on otherwise normal multidetector CT scans in patients suspected of having acute appendicitis, nonvisualization of the appendix was negative for appendicitis in 98% (95% CI: 71%, 100%) of cases. Conversely, when the appendix was seen at multidetector CT and was abnormal, appendicitis was present in 95% (95% CI: 72%, 100%) of cases.
In patients with right lower quadrant pain, a nonvisualized appendix at multidetector CT reliably excludes acute appendicitis.
回顾性确定在考虑为阑尾炎的急性右下腹疼痛患者中，多排螺旋计算机断层扫描（CT）检查时未显影阑尾的价值。
本符合健康保险流通与责任法案（HIPAA）的研究获得了机构审查委员会的批准，并免除了知情同意。回顾性分析2003年4月29日至10月31日期间因右下腹疼痛就诊于急诊科患者的记录。使用同一台八排螺旋CT扫描仪进行扫描，口服（除非有禁忌）及静脉注射对比剂，并获得横断位和冠状位图像。两名放射科医生在检查时对所有扫描图像进行前瞻性评估并达成共识意见。对阑尾未显影的患者进行至少3个月的回顾性临床随访，以确定是否发生阑尾炎。进行统计学分析并计算带有置信区间（CI）的百分比。
在连续接受多排螺旋CT检查的400例患者中，男性132例（33.0%），女性268例（67.0%）。80例（20.0%）患有急性阑尾炎，79例（19.8%）有其他腹痛原因。182例（45.5%）患者阑尾正常且无其他疼痛原因。59例（14.8%）患者阑尾未显影。在这59例患者中，50例有充分的随访。这50例患者中有49例临床随访无异常。因此，在怀疑患有急性阑尾炎的患者中，其他方面正常的多排螺旋CT扫描显示阑尾未显影时，98%（95%CI：71%，100%）的病例可排除阑尾炎。相反，当多排螺旋CT显示阑尾且阑尾异常时，95%（95%CI：72%，100%）的病例患有阑尾炎。
在右下腹疼痛患者中，多排螺旋CT检查时阑尾未显影可可靠地排除急性阑尾炎。
