Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, 149 Sangil-dong, Gangdong-gu, Seoul 134-727, Republic of Korea.
Eur Radiol. 2012 Jun;22(6):1178-85. doi: 10.1007/s00330-011-2362-5. Epub 2011 Dec 23.
To identify CT features that discriminate individuals with and without acute appendicitis in patients with equivocal CT findings, and to assess whether knowledge of these findings improves diagnostic accuracy.
53 patients that underwent appendectomy with an indeterminate preoperative CT interpretation were selected and allocated to an acute appendicitis group or a non-appendicitis group. The 53 CT examinations were reviewed by two radiologists in consensus to identify CT findings that could aid in the discrimination of those with and without appendicitis. In addition, two additional radiologists were then requested to evaluate independently the 53 CT examinations using a 4-point scale, both before and after being informed of the potentially discriminating criteria.
CT findings found to be significantly different in the two groups were; the presence of appendiceal wall enhancement, intraluminal air in appendix, a coexistent inflammatory lesion, and appendiceal wall thickening (P < 0.05). Areas under the curves of reviewers 1 and 2 significantly increased from 0.516 and 0.706 to 0.677 and 0.841, respectively, when reviewers were told which CT variables were significant (P = 0.0193 and P = 0.0397, respectively).
Knowledge of the identified CT findings was found to improve diagnostic accuracy for acute appendicitis in patients with equivocal CT findings.
• Numerous patients with clinically equivocal appendicitis do not have acute appendicitis • Computed tomography (CT) helps to reduce the negative appendectomy rate • CT is not always infallible and may also demonstrate indeterminate findings • However knowledge of significant CT variables can further reduce negative appendectomy rate • An equivocal CT interpretation of appendicitis should be reassessed with this knowledge.
在疑似 CT 表现的患者中，确定有助于鉴别急性阑尾炎和非阑尾炎的 CT 特征，并评估这些特征的知识是否能提高诊断准确性。
选择了 53 例接受阑尾切除术且术前 CT 检查结果不确定的患者，并将其分为急性阑尾炎组和非阑尾炎组。由两名放射科医生共同对 53 次 CT 检查进行回顾性分析，以确定有助于鉴别阑尾炎和非阑尾炎的 CT 表现。此外，然后要求另外两名放射科医生在独立评估 53 次 CT 检查时使用 4 分制，在被告知潜在鉴别标准前后分别进行评估。
两组间存在显著差异的 CT 表现包括阑尾壁强化、阑尾腔内气体、并存炎症性病变和阑尾壁增厚（P < 0.05）。当告知医生哪些 CT 变量具有显著性时，第一和第二位审稿人的曲线下面积分别从 0.516 和 0.706 显著增加至 0.677 和 0.841（P = 0.0193 和 P = 0.0397）。
对于疑似 CT 表现的急性阑尾炎患者，了解这些 CT 表现可提高诊断准确性。
许多具有临床疑似阑尾炎的患者实际上并无急性阑尾炎。
计算机断层扫描（CT）有助于降低阴性阑尾切除术率。
CT 并非总是可靠的，也可能显示出不确定的结果。
然而，了解有意义的 CT 变量可以进一步降低阴性阑尾切除术率。
对于有可疑 CT 解读的阑尾炎，应在了解这些知识的基础上重新评估。
