Joint Department of Medical Imaging, University of Toronto, Princess Margaret Hospital, 3-920, 610 University Avenue, Toronto, Ontario, M5G 2 M9, Canada. martin.o'
Joint Department of Medical Imaging, University of Toronto, Toronto General Hospital, NCSB 1C572, 585 University Avenue, Toronto, Ontario, M5G 2 N2, Canada.
Eur Radiol. 2016 Feb;26(2):532-8. doi: 10.1007/s00330-015-3778-0. Epub 2015 Oct 31.
To determine superior-inferior anatomic borders for CT following inconclusive/nondiagnostic US for possible appendicitis.
Ninety-nine patients with possible appendicitis and inconclusive/nondiagnostic US followed by CT were included in this retrospective study. Two radiologists reviewed CT images and determined superior-inferior anatomic borders required to diagnose or exclude appendicitis and diagnose alternative causes. This "targeted" coverage was used to estimate potential reduction in anatomic coverage compared to standard abdominal/pelvic CT.
The study group included 83 women and 16 men; mean age 32 (median, 29; range 18-73) years. Final diagnoses were: nonspecific abdominal pain 50/99 (51%), appendicitis 26/99 (26%), gynaecological 12/99 (12%), gastrointestinal 9/99 (10%), and musculoskeletal 2/99 (2%). Median dose-length product for standard CT was 890.0 (range, 306.3 - 2493.9) mGy.cm. To confidently diagnose/exclude appendicitis or identify alternative diagnoses, maximum superior-inferior anatomic CT coverage was the superior border of L2-superior border of pubic symphysis, for both reviewers. Targeted CT would reduce anatomic coverage by 30-55% (mean 39%, median 40%) compared to standard CT.
When CT is performed for appendicitis following inconclusive/nondiagnostic US, targeted CT from the superior border of L2-superior border of pubic symphysis can be used resulting in significant reduction in exposure to ionizing radiation compared to standard CT.
• When CT is used following inconclusive/ nondiagnostic ultrasound, anatomic coverage can be reduced. • CT from L2 to pubic symphysis can be used to diagnose/exclude appendicitis. • Reduced anatomic coverage for CT results in reduced exposure to ionizing radiation.
确定 CT 在疑似阑尾炎的超声检查结果不确定/无诊断价值后的上下解剖边界。
本回顾性研究纳入了 99 例疑似阑尾炎且超声检查结果不确定/无诊断价值，随后行 CT 检查的患者。两名放射科医生对 CT 图像进行了回顾，并确定了诊断或排除阑尾炎和诊断其他病因所需的上下解剖边界。这种“靶向”覆盖范围用于估计与标准腹部/盆腔 CT 相比，解剖覆盖范围的潜在减少。
研究组包括 83 名女性和 16 名男性；平均年龄 32 岁（中位数 29 岁；范围 18-73 岁）。最终诊断为：非特异性腹痛 50/99（51%）、阑尾炎 26/99（26%）、妇科疾病 12/99（12%）、胃肠道疾病 9/99（10%）和肌肉骨骼疾病 2/99（2%）。标准 CT 的剂量长度乘积中位数为 890.0（范围 306.3-2493.9）mGy.cm。为了有信心地诊断/排除阑尾炎或识别其他诊断，两位审阅者均认为最大的上下 CT 覆盖范围是 L2 上缘至耻骨联合上缘。与标准 CT 相比，靶向 CT 可减少 30-55%（平均 39%，中位数 40%）的解剖覆盖范围。
当超声检查结果不确定/无诊断价值后行 CT 检查用于阑尾炎时，可采用从 L2 上缘至耻骨联合上缘的靶向 CT，与标准 CT 相比，可显著降低辐射暴露。
当超声检查结果不确定/无诊断价值时，可减少 CT 的解剖覆盖范围。
采用 L2 至耻骨联合的 CT 可用于诊断/排除阑尾炎。
CT 解剖覆盖范围的减少导致辐射暴露减少。
