Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada.
Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, 1276 South Park Street, Halifax, Nova Scotia B3H 2Y9, Canada.
Eur J Radiol. 2021 Nov;144:109992. doi: 10.1016/j.ejrad.2021.109992. Epub 2021 Oct 5.
To identify factors associated with false or indeterminate US result for suspected appendicitis, and assess whether multi-categorical reporting of US yields more precise estimates regarding the probability of appendicitis.
562 US examinations for suspected appendicitis between May 2013-April 2015 were categorized as true (77/562 true positives or true negatives) or false/indeterminate (485/562 false negatives, false positives or indeterminates) based on results from a prior study. Of 541 examinations with images available retrospectively, a category of A-E was assigned as follows: non-visualized appendix with secondary findings (A) absent or (B) present; appendix visualized and considered (C) negative, (D) equivocal, or (E) positive for appendicitis. The following factors were recorded: age; sex; scan time (daytime vs. off-hours); resident/fellow involvement; abdominal subspecialty radiologist; radiologist experience (>5 years or not); and tenderness on interrogation. Associations between factors and US result were assessed (t-tests, Fisher's exact test and multivariate logistic regression).
The true group had proportionally more males (18/77 (23.4%) vs. 66/485 (13.6%), p = 0.04) and patients with sonographic tenderness (43/77 (55.8%) vs. 132/353 (27.3%), p < 0.0001). There was no significant difference or association with other factors. On multivariate logistic regression, false/indeterminate results were 1.9 times (95% CIs 1.0-3.5) more likely among females and 3.8 times more likely in the absence of tenderness (95% CIs 2.3-6.4). The proportion of patients with appendicitis in categories A-E was 34/410 (8.3%), 24/44 (54.5%), 0/18 (0%), 0/3 (0%) and 61/66 (92.4%), respectively.
Females and absence of tenderness were associated with a false/indeterminate US. Categorical reporting provides more granular estimates of the post-test probability of appendicitis.
确定与疑似阑尾炎的超声结果假阳性或不确定相关的因素，并评估多分类报告的超声结果是否能更准确地估计阑尾炎的可能性。
2013 年 5 月至 2015 年 4 月间，对 562 例疑似阑尾炎的患者进行了超声检查，根据先前研究的结果，将其结果分为真阳性（77/562）或假阳性/不确定（485/562）。在 541 例可回顾性获取图像的检查中，将 A-E 分类如下：未可视化阑尾伴次要发现（A）无或（B）有；可视化阑尾并认为（C）阴性，（D）不确定，或（E）阳性。记录了以下因素：年龄；性别；扫描时间（白天与非工作时间）；住院医师/研究员参与；腹部专业放射科医师；放射科医生经验（>5 年或不足 5 年）；以及触诊压痛。评估了因素与超声结果之间的关系（t 检验、Fisher 确切检验和多变量逻辑回归）。
真阳性组中男性比例更高（18/77（23.4%）与 66/485（13.6%），p=0.04），且超声触诊压痛阳性的患者比例更高（43/77（55.8%）与 132/353（27.3%），p<0.0001）。其他因素无显著差异或无关联。多变量逻辑回归显示，女性的假阳性/不确定结果的可能性是男性的 1.9 倍（95%置信区间 1.0-3.5），而无压痛的可能性是男性的 3.8 倍（95%置信区间 2.3-6.4）。A-E 类别的患者中阑尾炎的比例分别为 34/410（8.3%）、24/44（54.5%）、0/18（0%）、0/3（0%）和 61/66（92.4%）。
女性和无压痛与超声结果的假阳性/不确定相关。分类报告可提供更准确的阑尾炎后验概率估计。
