Schulte B, Beyer D, Kaiser C, Horsch S, Wiater A
Department of Diagnostic and Interventional Radiology, Academic Teaching Hospital Cologne-Porz, University of Cologne Medical School, Urbacher Weg 19, Krankenhaus Porz am Rhein, D-51149, Köln, Germany.
Eur J Ultrasound. 1998 Dec;8(3):177-82. doi: 10.1016/s0929-8266(98)00075-5.
For the assessment of the diagnostic value of real-time ultrasonography (US) in children with suspected acute appendicitis (a.A.) the results of graded compression US are compared with clinical and histological final diagnoses.
In a prospective study over nearly 9 years we examined 1285 children aged 1-15 years (m=514, f=771). Using a 5-MHz curved array transducer the right lower quadrant was examined in a graded compression technique.
Prevalence of histologically proven a.A. was remarkably low (9%). In diagnosis of acute appendicitis in childhood US achieves a sensitivity of 92%, specificity of 98%, a positive predictive value of 90% and a negative predictive value of 98%. The overall accuracy was 98%. Mesenteric lymphadenitis was seen in 181 cases (prevalence 12%) and terminal ileitis occasionally accompanied by mesenteric lymphadenitis was seen in 116 cases (prevalence 9%).
In children with suspected appendicitis US of the abdomen gives great diagnostical value for differential diagnosis of a.A. and other more frequent inflammatory diseases of the ileocoecal region. Thus US provides further reliable information to the referring physician. Consequently it is necessary to perform US in each child with acute abdominal pain, even if clinical diagnosis seems to be well established.
为评估实时超声检查（US）对疑似急性阑尾炎（a.A.）患儿的诊断价值，将分级加压超声检查结果与临床及组织学最终诊断结果进行比较。
在一项为期近9年的前瞻性研究中，我们检查了1285名1至15岁的儿童（男514名，女771名）。使用5兆赫的弧形阵列换能器，采用分级加压技术对右下腹进行检查。
经组织学证实的a.A.患病率极低（9%）。在儿童急性阑尾炎的诊断中，超声检查的敏感性为92%，特异性为98%，阳性预测值为90%，阴性预测值为98%。总体准确率为98%。181例可见肠系膜淋巴结炎（患病率12%），116例可见末端回肠炎并偶尔伴有肠系膜淋巴结炎（患病率9%）。
对于疑似阑尾炎的患儿，腹部超声检查对a.A.与回盲部其他更常见的炎症性疾病的鉴别诊断具有重要诊断价值。因此，超声可为转诊医生提供进一步可靠的信息。所以，对于每一名急性腹痛患儿，即使临床诊断似乎已明确，也有必要进行超声检查。
