Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Curr Probl Diagn Radiol. 2021 May-Jun;50(3):315-320. doi: 10.1067/j.cpradiol.2020.01.010. Epub 2020 Jan 9.
Acute appendicitis is one of the most common causes of acute abdominal pain requiring emergency intervention. It is often difficult for the clinician to make an accurate diagnosis due to nonspecific and overlapping clinical symptoms. Computed tomography (CT) has become the imaging modality of choice for the evaluation of suspected acute appendicitis. The main purpose of our study was to compare nonenhanced CT (NECT) with contrast-enhanced CT (CECT) for the diagnosis of acute appendicitis.
A total of 140 patients were enrolled in the study. Two abdominal radiologists-masked to both the clinical information and the final diagnosis-retrospectively reviewed the computed tomographic findings and made an imaging diagnosis based on (1) NECT only, (2) CECT only, and (3) both NECT and CECT. With the final diagnosis as the reference standard, the accuracy of each CT technique was estimated.
The respective sensitivity, specificity, and accuracy for NECT, CECT, and NECT + CECT for the diagnosis of acute appendicitis were 80.7%, 86.7%, and 84.3%; 86.0%, 81.9%, and 83.6%; and, 87.7%, 80.7%, and 83.6%. There was no significant difference in the diagnosis of acute appendicitis among the 3 techniques. In order to make a correct diagnosis, the presence of at least 3 imaging findings for NECT or at least 4 for CECT had the best diagnostic accuracy. We also found that 9.25 mm was the optimal cut-off threshold for the detection of patients with acute appendicitis.
Our study allowed direct comparison between NECT, CECT, and NECT + CECT combined. There was no difference in the ability of each CT technique for diagnosing patients with acute appendicitis. For a patient whom iodinated contrast media is contraindicated or a patient who has an increased risk of severe adverse reaction, we would encourage the use of NECT because it provides comparable diagnostic accuracy without further exposing such patient to the contrast media.
急性阑尾炎是最常见的需要紧急干预的急性腹痛原因之一。由于临床表现非特异性且有重叠，临床医生往往难以做出准确的诊断。计算机断层扫描（CT）已成为评估疑似急性阑尾炎的首选影像学方法。我们研究的主要目的是比较非增强 CT（NECT）与增强 CT（CECT）在诊断急性阑尾炎中的作用。
共纳入 140 例患者。两名腹部放射科医生（对临床信息和最终诊断均不知情）回顾性地分析了 CT 表现，并根据以下三种方法进行影像学诊断：（1）仅NECT；（2）仅 CECT；（3）NECT 和 CECT 联合。以最终诊断为参考标准，评估每种 CT 技术的准确性。
NECT、CECT 和 NECT+CECT 诊断急性阑尾炎的敏感性、特异性和准确性分别为 80.7%、86.7%和 84.3%；86.0%、81.9%和 83.6%；87.7%、80.7%和 83.6%。三种技术诊断急性阑尾炎的准确性无显著差异。为了做出正确诊断，NECT 至少有 3 种影像表现或 CECT 至少有 4 种影像表现的诊断准确性最佳。我们还发现，9.25mm 是检测急性阑尾炎患者的最佳截断值。
本研究允许直接比较 NECT、CECT 和 NECT+CECT 联合。每种 CT 技术诊断急性阑尾炎的能力没有差异。对于碘造影剂禁忌或有发生严重不良反应风险增加的患者，我们鼓励使用 NECT，因为它可以提供相当的诊断准确性，而无需使此类患者进一步接触造影剂。
