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疑似阑尾炎的青少年和年轻成人中,2mSv CT 与常规剂量 CT 检查结果不确定时的最终诊断和患者处理:大型实用随机试验数据的事后分析。

Final diagnosis and patient disposition following equivocal results on 2-mSv CT vs. conventional-dose CT in adolescents and young adults with suspected appendicitis: a post hoc analysis of large pragmatic randomized trial data.

机构信息

Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.

Department of Applied Bioengineering, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Korea.

出版信息

Eur Radiol. 2021 Dec;31(12):9176-9187. doi: 10.1007/s00330-021-08020-7. Epub 2021 May 15.

Abstract

OBJECTIVE

To compare 2-mSv CT and conventional-dose CT (CDCT, typically 7-8 mSv) regarding final diagnosis and patient disposition following equivocal CT results in adolescents and young adults with suspected appendicitis.

METHODS

In total, 3074 patients of 15-44 years (28 ± 9 years, 1672 women) from 20 hospitals were randomized to undergo contrast-enhanced 2-mSv CT (n = 1535) or CDCT (n = 1539) from December 2013 through August 2016. One hundred sixty-one radiologists prospectively rated the likelihood of appendicitis in a Likert scale (i.e., grades 1-5). The final diagnosis was based on CT image, surgical, pathologic, and clinical findings. Post hoc analysis was performed for final diagnosis, surgical procedure, and delay in patient management following equivocal results (i.e., grade 3).

RESULTS

The 2-mSv CT and CDCT groups were comparable for final diagnosis following equivocal results, including confirmed appendicitis (1.2% [18 patients] vs. 1.2% [19], p > 0.99), negative appendectomy (0.1% [2] vs. 0.3% [4], p = 0.53), and perforated appendicitis (0.1% [1] vs. 0.2% [3], p = 0.53). More patients were confirmed as not having appendicitis following equivocal results in the CDCT group than in the 2-mSv CT group (2.2% [34] vs. 1.0% [16], p = 0.016). The two groups were comparable for the need of appendectomy (1.4% [22] vs. 1.5% [23], p > 0.99), need of additional imaging tests (0.7% [11] vs. 1.1% [17], p = 0.35), and delay in patient management following equivocal results.

CONCLUSION

2-mSv CT is comparable to CDCT regarding final diagnosis and patient disposition following equivocal CT results.

KEY POINTS

• Our results strengthen evidence justifying the use of low-dose CT instead of conventional-dose CT (CDCT) in adolescents and young adults with suspected appendicitis. • The 2-mSv CT and CDCT groups were comparable for final diagnosis following equivocal CT results, including confirmed appendicitis (1.2% vs. 1.2%, p > 0.99), negative appendectomy (0.1% vs. 0.3%, p = 0.53), and perforated appendicitis (0.1% vs. 0.2%, p = 0.53). • The two groups were comparable for the need for appendectomy (1.4% vs. 1.5%, p > 0.99), need for additional imaging tests (0.7% vs. 1.1%, p = 0.35), and delay in patient management, following equivocal CT results.

摘要

目的

比较疑似阑尾炎的青少年和年轻患者中,在疑似 CT 结果不确定时,2 毫西弗 CT(2-mSv CT)和常规剂量 CT(CDCT,通常为 7-8 毫西弗)在最终诊断和患者处置方面的差异。

方法

共有 20 家医院的 3074 名 15-44 岁(28±9 岁,1672 名女性)患者参与了研究,他们于 2013 年 12 月至 2016 年 8 月期间被随机分配至行增强 2-mSv CT(n=1535)或 CDCT(n=1539)。161 名放射科医生前瞻性地对阑尾炎可能性进行了 Likert 量表评分(即,1-5 级)。最终诊断基于 CT 图像、手术、病理和临床发现。对不确定结果(即 3 级)后的最终诊断、手术程序和患者管理延迟进行了事后分析。

结果

在不确定结果的最终诊断方面,2-mSv CT 和 CDCT 组无显著差异,包括确诊阑尾炎(1.2%[18 例]与 1.2%[19 例],p>0.99)、阴性阑尾切除术(0.1%[2 例]与 0.3%[4 例],p=0.53)和穿孔性阑尾炎(0.1%[1 例]与 0.2%[3 例],p=0.53)。与 CDCT 组相比,在不确定结果后,更多患者被确认为未患阑尾炎(2-mSv CT 组为 1.0%[16 例],CDCT 组为 2.2%[34 例],p=0.016)。两组在需要行阑尾切除术(1.4%[22 例]与 1.5%[23 例],p>0.99)、需要进行其他影像学检查(0.7%[11 例]与 1.1%[17 例],p=0.35)和不确定结果后患者管理延迟方面无显著差异。

结论

2-mSv CT 与 CDCT 在不确定 CT 结果后的最终诊断和患者处置方面相当。

要点

  1. 我们的研究结果为支持在疑似阑尾炎的青少年和年轻患者中使用低剂量 CT 替代常规剂量 CT(CDCT)提供了更多证据。

  2. 在不确定 CT 结果的最终诊断方面,2-mSv CT 和 CDCT 组无显著差异,包括确诊阑尾炎(1.2%与 1.2%,p>0.99)、阴性阑尾切除术(0.1%与 0.3%,p=0.53)和穿孔性阑尾炎(0.1%与 0.2%,p=0.53)。

  3. 两组在需要行阑尾切除术(1.4%与 1.5%,p>0.99)、需要进行其他影像学检查(0.7%与 1.1%,p=0.35)和不确定结果后患者管理延迟方面无显著差异。

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