Department of Radiology, University of Wisconsin School of Medicine and Public Health, E3/311 Clinical Sciences Center, 600 Highland Ave, Madison, WI, 53792, USA.
Abdom Radiol (NY). 2022 Jun;47(6):2209-2219. doi: 10.1007/s00261-022-03504-6. Epub 2022 Apr 8.
To determine the clinical impact of the second examination when both CT and TVUS are obtained in the same ED visit for acute pelvic/lower abdominal symptoms in non-pregnant premenopausal women.
200 consecutive non-pregnant premenopausal women (mean age, 31.8 years; range, 18-49 years) who underwent both ED-based TVUS and abdominopelvic CT evaluation for acute symptoms over a 12 month period were included; 107 women had TVUS first, followed by CT; 93 women had CT first. All relevant clinical, radiologic, and pathologic findings were reviewed to establish a final diagnosis. Any additional clinical impact provided by the second imaging test was assessed by two experienced abdominal radiologists.
Initial TVUS was interpreted as normal (n = 63) or mentioned incidental findings (n = 11) in 69% (74/107); subsequent CT established a non-gynecologic GI/GU etiology in 25 (34%). For 37% (34/93) of CT exams interpreted as normal, TVUS added no new information. In 32 cases (34%), TVUS further excluded ovarian torsion/adnexal pathology when initial CT was indeterminate/equivocal. Overall, CT following TVUS provided a key new or alternative diagnosis in 26% (28/107), whereas TVUS after CT provided a relevant new/alternative diagnosis in only 1/93 cases (p < 0.001). In nine cases (8%), CT confirmed a positive US diagnosis but detected relevant additional diagnostic information.
CT following negative TVUS frequently identified a non-gynecologic cause of acute pelvic or lower abdominal symptoms in non-pregnant premenopausal women, whereas the main benefit of TVUS after CT was more confident exclusion of ovarian torsion.
确定在急诊就诊时同时进行 CT 和 TVUS 检查用于非妊娠绝经前女性急性盆腔/下腹部症状的第二次检查的临床影响。
纳入 200 例连续的非妊娠绝经前女性（平均年龄 31.8 岁；范围 18-49 岁），她们在 12 个月期间因急性症状在急诊接受了基于 TVUS 的腹部盆腔 CT 评估；107 例女性先进行 TVUS 检查，随后进行 CT 检查；93 例女性先进行 CT 检查。所有相关的临床、放射学和病理学发现均进行了回顾，以确定最终诊断。两位经验丰富的腹部放射科医生评估了第二次影像学检查提供的任何额外临床影响。
初始 TVUS 检查结果为正常（n=63）或偶然发现异常（n=11）的比例为 69%（74/107）；随后的 CT 检查确定了 25 例（34%）非妇科的胃肠道/泌尿系统病因。对于 37%（34/93）的 CT 检查结果正常的患者，TVUS 没有提供新的信息。在 32 例（34%）情况下，初始 CT 结果不确定/不确定时，TVUS 进一步排除了卵巢扭转/附件病变。总的来说，TVUS 后进行 CT 检查提供了 26%（28/107）的关键新诊断或替代诊断，而 CT 后进行 TVUS 检查仅提供了 1 例（1/93）新的/替代诊断（p<0.001）。在 9 例（8%）的情况下，CT 检查证实了超声检查的阳性诊断，但检测到了相关的额外诊断信息。
阴性 TVUS 后进行 CT 检查经常能识别非妊娠绝经前女性急性盆腔或下腹部症状的非妇科原因，而 CT 后进行 TVUS 的主要益处是更有信心地排除卵巢扭转。
