Koberlein George C, Trout Andrew T, Rigsby Cynthia K, Iyer Ramesh S, Alazraki Adina L, Anupindi Sudha A, Bardo Dianna M E, Brown Brandon P, Chan Sherwin S, Chandra Tushar, Dillman Jonathan R, Dorfman Scott R, Falcone Richard A, Garber Matthew D, Joseph Madeline M, Nguyen Jie C, Safdar Nabile M, Karmazyn Boaz
Research Author, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Am Coll Radiol. 2019 May;16(5S):S252-S263. doi: 10.1016/j.jacr.2019.02.022.
Acute appendicitis represents the most common abdominal surgical urgency/emergency in children. Imaging remains a central tool in the diagnosis of acute appendicitis and has been shown to facilitate management and decrease the rate of negative appendectomies. The initial consideration for imaging in a child with suspected acute appendicitis is based on clinical assessment, which can be facilitated with published scoring systems. The level of clinical risk (low, intermediate, high) and the clinical scenario (suspicion for complication) define the need for imaging and the optimal imaging modality. In some situations, no imaging is required, while in others ultrasound, CT, or MRI may be appropriate. This review frames the presentation of suspected acute appendicitis in terms of the clinical risk and also discusses the unique situations of the equivocal or nondiagnostic initial ultrasound examination and suspected appendicitis with suspicion for complication (eg, bowel obstruction). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
急性阑尾炎是儿童最常见的腹部外科急症。影像学检查仍然是诊断急性阑尾炎的核心手段，已被证明有助于治疗管理并降低阴性阑尾切除术的发生率。对于疑似急性阑尾炎的儿童，影像学检查的初步考虑基于临床评估，已发表的评分系统有助于临床评估。临床风险水平（低、中、高）和临床情况（怀疑有并发症）决定了是否需要进行影像学检查以及最佳的影像学检查方式。在某些情况下，无需进行影像学检查，而在其他情况下，超声、CT或MRI可能是合适的。本综述根据临床风险阐述了疑似急性阑尾炎的表现，还讨论了超声检查结果不明确或无法诊断的特殊情况以及疑似阑尾炎伴有并发症（如肠梗阻）的情况。美国放射学会适宜性标准是针对特定临床情况的循证指南，由多学科专家小组每年进行审查。指南的制定和修订包括对同行评审期刊上当前医学文献的广泛分析，以及应用成熟的方法（兰德/加州大学洛杉矶分校适宜性方法和推荐分级评估、制定与评价或GRADE）来评估特定临床情况下影像学检查和治疗程序的适宜性。在缺乏证据或证据不明确的情况下，专家意见可能会补充现有证据以推荐影像学检查或治疗方法。
