Department of Radiology, Galway University Hospital, Galway, Ireland.
Departmentof Radiology, St Vincents University Hospital, Elm park, Dublin, Ireland.
Br J Radiol. 2019 Jan;92(1093):20180585. doi: 10.1259/bjr.20180585. Epub 2018 Sep 12.
To compare pre-operative ultrasound to histopathological results and retrospectively assess the diagnostic accuracy of ultrasound in paediatric appendicitis.
5 year review of all appendectomies performed in patients <16 years old in a tertiary referral university hospital. 983 patients had an appendicectomy over the time period while 189 patients had a preoperative ultrasound. We retrospectively reviewed all of the preoperative imaging in conjunction with the reports for the 189 patients; our aim was to determine the sensitivity of preoperative ultrasound for the diagnosis of acute appendicitis.
Of the 189 patients who had an ultrasound, 102 had histology positive for appendicitis and 87 had normal histology. Sensitivity overall was 72.55% [95% confidence interval (CI) 62.82 to 80.92] and specificity was 77.01% (95% CI 66.75 to 85.36). A suggested ultrasound diagnosis of appendicitis made positive pathology three times more likely and a normal ultrasound made positive pathology three times less likely [positive-predictive value 3.16 (95% CI 2.11 to 4.72) negative predictive value 0.36 (95% CI 0.25 to 0.50)]. 77% (67/87) of the patients whose pathology was ultimately normal had an ultrasound which was either normal or suggested an alternative diagnosis. However, in the 33 (17%) of patients with a non-visualised appendix, no secondary signs of inflammation or alternative diagnosis 16 (48%) had pathologically confirmed appendicitis.
Ultrasound has the potential to improve diagnostic accuracy in clinically ambiguous appendicitis.
This paper furthers the evidence on the efficacy of ultrasound as a diagnostic tool in acute appendicitis in children, especially when the diagnosis is clinically equivocal. It also sheds further light on the "non-visualized appendix" with almost half of these patients having pathologically confirmed appendicitis; meaning advanced imaging with CT or MR may be indicated in this cohort.
比较术前超声与组织病理学结果，并回顾性评估超声在儿科阑尾炎中的诊断准确性。
对一家三级转诊大学医院中 16 岁以下患者进行的所有阑尾切除术进行了 5 年回顾。在此期间，有 983 名患者接受了阑尾切除术，而有 189 名患者接受了术前超声检查。我们回顾性地对所有术前影像学检查和 189 名患者的报告进行了检查；我们的目的是确定术前超声对急性阑尾炎诊断的敏感性。
在 189 名接受超声检查的患者中，有 102 名患者的组织学检查结果为阑尾炎阳性，87 名患者的组织学检查结果为正常。总体敏感性为 72.55%[95%置信区间（CI）62.82%至 80.92%]，特异性为 77.01%（95%CI 66.75%至 85.36%）。提示超声诊断阑尾炎的阳性病理检查结果可能性增加三倍，而正常超声检查的阳性病理检查结果可能性降低三倍[阳性预测值 3.16（95%CI 2.11 至 4.72），阴性预测值 0.36（95%CI 0.25 至 0.50）]。最终病理检查结果正常的 87 名患者中，有 77%（67/87）的患者超声检查结果正常或提示其他诊断。然而，在 33 名（17%）阑尾未显示的患者中，没有其他炎症的次要征象或其他诊断，其中 16 名（48%）的患者病理检查证实患有阑尾炎。
超声有可能提高临床上不明确阑尾炎的诊断准确性。
本文进一步证明了超声作为儿童急性阑尾炎诊断工具的疗效，尤其是在临床诊断不确定的情况下。它还进一步揭示了“未显示的阑尾”，其中近一半的患者病理检查证实患有阑尾炎；这意味着在这一队列中可能需要进行 CT 或 MR 等高级影像学检查。
