1 Division of Digestive Surgery and Urology, Department of Acute and Digestive Surgery, Turku University Hospital, Turku, Finland.
2 Department of Surgery, University of Turku, Turku, Finland.
Scand J Surg. 2018 Mar;107(1):43-47. doi: 10.1177/1457496917731189. Epub 2017 Sep 20.
To assess the accuracy of computed tomography in diagnosing acute appendicitis with a special reference to radiologist experience.
Data were collected prospectively in our randomized controlled trial comparing surgery and antibiotic treatment for uncomplicated acute appendicitis (APPAC trial, NCT01022567). We evaluated 1065 patients who underwent computed tomography for suspected appendicitis. The on-call radiologist preoperatively analyzed these computed tomography images. In this study, the radiologists were divided into experienced (consultants) and inexperienced (residents) ones, and the comparison of interpretations was made between these two radiologist groups.
Out of the 1065 patients, 714 had acute appendicitis and 351 had other or no diagnosis on computed tomography. There were 700 true-positive, 327 true-negative, 14 false-positive, and 24 false-negative cases. The sensitivity and the specificity of computed tomography were 96.7% (95% confidence interval, 95.1-97.8) and 95.9% (95% confidence interval, 93.2-97.5), respectively. The rate of false computed tomography diagnosis was 4.2% for experienced consultant radiologists and 2.2% for inexperienced resident radiologists (p = 0.071). Thus, the experience of the radiologist had no effect on the accuracy of computed tomography diagnosis.
The accuracy of computed tomography in diagnosing acute appendicitis was high. The experience of the radiologist did not improve the diagnostic accuracy. The results emphasize the role of computed tomography as an accurate modality in daily routine diagnostics for acute appendicitis in all clinical emergency settings.
评估计算机断层扫描（CT）在诊断急性阑尾炎方面的准确性，特别关注放射科医生的经验。
我们在一项比较单纯性急性阑尾炎手术与抗生素治疗的随机对照试验（APPAC 试验，NCT01022567）中前瞻性收集数据。我们评估了 1065 例疑似阑尾炎行 CT 检查的患者。值班放射科医生术前对这些 CT 图像进行分析。在本研究中，放射科医生分为有经验（顾问）和无经验（住院医师）两组，并对这两组放射科医生的解释进行了比较。
在 1065 例患者中，714 例为急性阑尾炎，351 例 CT 检查诊断为其他疾病或无诊断。真阳性 700 例，真阴性 327 例，假阳性 14 例，假阴性 24 例。CT 检查的敏感性和特异性分别为 96.7%（95%置信区间，95.1-97.8）和 95.9%（95%置信区间，93.2-97.5）。有经验的顾问放射科医生和无经验的住院医师的假 CT 诊断率分别为 4.2%和 2.2%（p=0.071）。因此，放射科医生的经验对 CT 诊断的准确性没有影响。
CT 诊断急性阑尾炎的准确性较高。放射科医生的经验并不能提高诊断的准确性。这些结果强调了 CT 在所有临床急诊环境下作为急性阑尾炎日常诊断中一种准确的检查方法的作用。
