Sim Ji Ye, Kim Hyuk Jung, Jang Suk Ki, Yeon Jae Woo, Jeon Byeong Geon, Ha Young Rock, Paik So Ya, Cho June Sik
Department of Radiology, Hanil General Hospital, Seoul, South Korea.
Department of Radiology, Daejin Medical Center, Bundang Jesaeng General Hospital, Seongnam-Si, Gyeonggi-Do, South Korea.
J Med Ultrasound. 2019 Apr-Jun;27(2):75-80. doi: 10.4103/JMU.JMU_52_18. Epub 2019 May 7.
The objective of this study was to find the diagnostic values of additional ultrasound (US) in patients with equivocal computed tomography (CT) findings of acute appendicitis, compared to CT reassessment.
Patients with equivocal CT findings of acute appendicitis ( = 115), who underwent the US, were included in the study. Two abdominal radiologists reviewed CT scans independently. They analyzed CT findings and made a diagnosis of acute appendicitis. The patients were categorized into positive and negative appendicitis based on the previous US reports. The diagnostic performance, interobserver agreement of CT findings, and appendicitis likelihood were calculated.
The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US (100%, 92.1%, 79.5%, and 100%, respectively) were higher than those of CT reassessment (reviewer 1: 51.9%, 87.5%, 56.1%, and 85.6%; reviewer 2: 66.7%, 85.2%, 58.1%, and 89.3%, respectively). In the coexistent inflammation group, the sensitivity, specificity, PPV, and NPV of US (reviewer 1: 100%, 98%, 91.5%, and 100%; reviewer 2: 100%, 98%, 87.7%, and 100%, respectively) were higher than those of CT reassessment (reviewer 1: 27.3%, 94.1%, 49.9%, and 85.8%; reviewer 2: 14.3%, 98.0%, 50.5%, and 88.9%, respectively).
In patients with equivocal CT findings of acute appendicitis, US shows better diagnostic performance than CT reassessment, and helps differentiate with periappendicitis.
本研究的目的是比较附加超声（US）与CT重新评估对急性阑尾炎CT表现不明确患者的诊断价值。
本研究纳入了115例急性阑尾炎CT表现不明确且接受了超声检查的患者。两名腹部放射科医生独立复查CT扫描。他们分析CT表现并做出急性阑尾炎的诊断。根据之前的超声报告，将患者分为阑尾炎阳性和阴性。计算诊断性能、CT表现的观察者间一致性以及阑尾炎可能性。
超声的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）（分别为100%、92.1%、79.5%和100%）高于CT重新评估（审阅者1：分别为51.9%、87.5%、56.1%和85.6%；审阅者2：分别为66.7%、85.2%、58.1%和89.3%）。在并存炎症组中，超声的敏感性、特异性、PPV和NPV（审阅者1：分别为100%、98%、91.5%和100%；审阅者2：分别为100%、98%、87.7%和100%）高于CT重新评估（审阅者1：分别为27.3%、94.1%、49.9%和85.8%；审阅者2：分别为14.3%、98.0%、50.5%和88.9%）。
对于急性阑尾炎CT表现不明确的患者，超声的诊断性能优于CT重新评估，并有助于与阑尾周围炎相鉴别。
