Tan Victoria F, Patlas Michael N, Katz Douglas S
Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton, ON, Canada.
Division of Emergency/Trauma Radiology, Department of Radiology, Hamilton General Hospital, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.
Emerg Radiol. 2017 Jun;24(3):249-254. doi: 10.1007/s10140-016-1472-4. Epub 2016 Dec 8.
The purpose of our study was to assess trends in the imaging of suspected appendicitis in adult patients in emergency departments of academic centers in Canada.
A questionnaire was sent to all 17 academic centers in Canada to be completed by a radiologist who works in emergency radiology. The questionnaires were sent and collected over a period of 4 months from October 2015 to February 2016.
Sixteen centers (94%) responded to the questionnaire. Eleven respondents (73%) use IV contrast-enhanced computed tomography (CT) as the imaging modality of choice for all patients with suspected appendicitis. Thirteen respondents (81%) use ultrasound as the first modality of choice in imaging pregnant patients with suspected appendicitis. Eleven respondents (69%) use ultrasound (US) as the first modality of choice in patients younger than 40 years of age. Ten respondents (67%) use ultrasound as the first imaging modality in female patients younger than 40 years of age. When CT is used, 81% use non-focused CT of the abdomen and pelvis, and 44% of centers use oral contrast. Thirteen centers (81%) have ultrasound available 24 h a day/7 days a week. At 12 centers (75%), ultrasound is performed by ultrasound technologists. Four centers (40%) perform magnetic resonance imaging (MRI) in suspected appendicitis in adult patients at the discretion of the attending radiologist. Eleven centers (69%) have MRI available 24/7. All 16 centers (100%) use unenhanced MRI.
Various imaging modalities are available for the work-up of suspected appendicitis. Although there are North American societal guidelines and recommendations regarding the appropriateness of the multiple imaging modalities, significant heterogeneity in the first-line modalities exist, which vary depending on the patient demographics and resource availability. Imaging trends in the use of the first-line modalities should be considered in order to plan for the availability of the imaging examinations and to consider plans for an imaging algorithm to permit standardization across multiple centers. While this study examined the imaging trends specifically in Canada, there are implications to other countries seeking to streamline imaging protocols and determining appropriateness of the first-line imaging modalities.
我们研究的目的是评估加拿大各学术中心急诊科成年疑似阑尾炎患者的影像学检查趋势。
向加拿大所有17个学术中心发送了一份问卷，由从事急诊放射学工作的放射科医生填写。问卷于2015年10月至2016年2月的4个月内发送并收集。
16个中心（94%）回复了问卷。11名受访者（73%）将静脉注射对比增强计算机断层扫描（CT）作为所有疑似阑尾炎患者的首选影像学检查方式。13名受访者（81%）将超声作为疑似阑尾炎孕妇的首选影像学检查方式。11名受访者（69%）将超声作为40岁以下患者的首选影像学检查方式。10名受访者（67%）将超声作为40岁以下女性患者的首选影像学检查方式。使用CT时，81%使用腹部和盆腔非聚焦CT，44%的中心使用口服对比剂。13个中心（81%）每周7天、每天24小时提供超声检查。在12个中心（75%），超声检查由超声技师进行。4个中心（40%）根据主治放射科医生的判断，对成年疑似阑尾炎患者进行磁共振成像（MRI）检查。11个中心（69%）每周7天、每天24小时提供MRI检查。所有16个中心（100%）都使用非增强MRI。
对于疑似阑尾炎的检查，有多种影像学检查方式可供选择。尽管北美有关于多种影像学检查方式适用性的社会指南和建议，但一线检查方式存在显著异质性，这取决于患者的人口统计学特征和资源可用性。应考虑一线检查方式的使用趋势，以便规划影像学检查的可用性，并考虑制定影像学算法计划，以实现多个中心的标准化。虽然本研究专门考察了加拿大的影像学检查趋势，但对其他寻求简化影像学检查方案并确定一线影像学检查方式适用性的国家也有启示。
