Wongsaengchan Dhanawin, Chatpuwaphat Jitti, Thiravit Shanigarn, Tongsai Sasima, Noppakunsomboon Napakadol, Kaewlai Rathachai
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abdom Radiol (NY). 2025 Jul 17. doi: 10.1007/s00261-025-05124-2.
Low-keV virtual monoenergetic images on dual-energy CT (DECT) enhance iodine attenuation in inflamed appendiceal walls, but the role in differentiating complicated from uncomplicated appendicitis remains unclear. This is particularly relevant given the shift toward nonoperative management of uncomplicated appendicitis.
Consecutive adult patients with pathologically confirmed acute appendicitis who underwent preoperative rapid-kVP-switching DECT and appendectomy within 24 h were retrospectively included. Two radiologists reviewed DECT images, including a finding of appendiceal wall enhancement defects, using three series: 50-keV monoenergetic, 120-kVp-equivalent, and combined series, with discrepancies resolved by a third radiologist. Diagnostic performance of three series for differentiating complicated from uncomplicated appendicitis was assessed. Detection rates of appendiceal wall enhancement defects and radiologist confidence among three series were compared.
Among 155 patients (50 men, mean age 47.4±19.0 years), 59 had complicated appendicitis. The combined 50-keV/120-kVp-equivalent series provided balanced sensitivity (83.1%) and specificity (86.5%), with an accuracy of 85.2% in differentiating uncomplicated and complicated appendicitis. Although 50-keV images revealed the most wall enhancement defects (48/122; 39.3%), radiologists' confidence was significantly higher using the combined series (91.8% vs. 72.1%, p < 0.001).
Low-keV virtual monoenergetic DECT, when combined with 120-kVP-equivalent images, improved the detection of appendiceal wall enhancement defects and increased radiologist confidence in differentiating complicated from uncomplicated appendicitis in adult patients with acute appendicitis.
双能CT（DECT）的低keV虚拟单能量图像可增强发炎阑尾壁中的碘衰减，但在区分复杂性阑尾炎与非复杂性阑尾炎方面的作用仍不明确。鉴于非复杂性阑尾炎的治疗正朝着非手术管理方向转变，这一点尤为重要。
回顾性纳入连续的成年患者，这些患者经病理证实为急性阑尾炎，且在术前24小时内接受了快速kVp切换DECT检查和阑尾切除术。两名放射科医生使用三个系列（50-keV单能量、120-kVp等效和联合系列）对DECT图像进行了评估，包括阑尾壁强化缺损的发现，如有分歧则由第三名放射科医生解决。评估了三个系列在区分复杂性阑尾炎与非复杂性阑尾炎方面的诊断性能。比较了三个系列中阑尾壁强化缺损的检出率和放射科医生的信心。
在155例患者（50例男性，平均年龄47.4±19.0岁）中，59例患有复杂性阑尾炎。50-keV/120-kVp等效联合系列在区分非复杂性和复杂性阑尾炎方面提供了平衡的敏感性（83.1%）和特异性（86.5%），准确率为85.2%。尽管50-keV图像显示的壁强化缺损最多（48/122；39.3%），但放射科医生使用联合系列时的信心明显更高（91.8%对72.1%，p<0.001）。
低keV虚拟单能量DECT与120-kVp等效图像相结合，可提高对阑尾壁强化缺损的检测，并增加放射科医生在区分成年急性阑尾炎患者的复杂性与非复杂性阑尾炎方面的信心。
