Ma Li, Niu Zihan, Xu Wen, Wang Ruojiao, Gao Luying, Tao Xixi, Jiang Yuxin, Li Jianchu, Wang Hongyan
Peking Union Medical College Hospital, Beijing, China.
Abdom Radiol (NY). 2025 May;50(5):1979-1985. doi: 10.1007/s00261-024-04695-w. Epub 2024 Nov 21.
The role of cross-sectional imaging in the management of acute appendicitis (AA) is contentious. This study aimed to investigate the current usage and diagnostic performance of ultrasound (US) and computed tomography (CT).
A national survey was conducted by a core group from The National Ultrasound Quality and Control Center of China among radiologists practicing in medical institutions equipped with emergency departments and regularly performing appendectomies. Radiologists participated by completing the survey online from August 2022 to August 2023 after reviewing medical records of at least 40 patients with suspected AA. Sensitivity, specificity, positive predictive value, and negative predictive value and likelihood ratios were calculated for US and CT, respectively. Diagnostic performance of US between hospital subgroups were also compared.
A total of 141 questionnaires were submitted and 118 were eligible, each representing a distinct hospital. A total of 1844 children and 4165 adults were included. There were 76.4% patients underwent US studies, while 23.9% underwent CT studies. Higher percentage of children underwent US studies than adults (82.2% vs. 73.9%, P = 0.000). In children, the sensitivity and specificity of US were 89% and 90%, and of CT were 90% and 48%. In adults, the sensitivity and specificity of US were 92% and 84%, and of CT were 94% and 79%. The Likelihood ratios of US were higher in specialized hospitals (children's or children's and women's hospitals) than general hospitals (34.1 vs. 6.43).
US is more commonly used than CT for diagnosing AA in both adults and children. The diagnostic performance of US is comparable to CT. These findings underscore the recognition of US in clinical practice as a low-cost, non-radiative tool.
横断面成像在急性阑尾炎（AA）管理中的作用存在争议。本研究旨在调查超声（US）和计算机断层扫描（CT）的当前使用情况及诊断性能。
中国国家超声质量与控制中心的一个核心小组对在设有急诊科且定期进行阑尾切除术的医疗机构执业的放射科医生进行了一项全国性调查。放射科医生在2022年8月至2023年8月期间，在查阅至少40例疑似AA患者的病历后，通过在线方式完成调查。分别计算了US和CT的敏感性、特异性、阳性预测值、阴性预测值及似然比。还比较了不同医院亚组之间US的诊断性能。
共提交141份问卷，118份合格，每份代表一家不同的医院。共纳入1844名儿童和4165名成人。76.4%的患者接受了US检查，而23.9%的患者接受了CT检查。接受US检查的儿童比例高于成人（82.2%对73.9%，P = 0.000）。在儿童中，US的敏感性和特异性分别为89%和90%，CT的敏感性和特异性分别为90%和48%。在成人中，US的敏感性和特异性分别为92%和84%，CT的敏感性和特异性分别为94%和79%。专科医院（儿童医院或儿童与妇女医院）中US的似然比高于综合医院（34.1对6.43）。
在成人和儿童中，US用于诊断AA比CT更常用。US的诊断性能与CT相当。这些发现强调了在临床实践中认可US作为一种低成本、无辐射工具的重要性。
