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CT in Differentiating Complicated From Uncomplicated Appendicitis: Presence of Any of 10 CT Features Versus Radiologists Gestalt Assessment
Seoul Natl Univ, South Korea.
Seoul Natl Univ, South Korea.
Seoul Natl Univ, South Korea.
Inha Univ, South Korea.
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2019 (English)In: American Journal of Roentgenology, ISSN 0361-803X, E-ISSN 1546-3141, Vol. 213, no 5, p. W218-W226Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE. The purpose of this study is to propose a sensitive CT criterion (the presence of any of 10 CT features) for complicated appendicitis that could be used in the nonoperative management of appendicitis and to compare the diagnostic performance of this sensitive CT criterion with that of gestalt assessment. MATERIALS AND METHODS. This retrospective study, which was conducted in a tertiary teaching hospital, included 100 patients with suspected appendicitis on CT. Complicated appendicitis, defined as gangrenous or perforated appendicitis, was pathologically or surgically confirmed in 32 patients. Six radiologists independently determined the presence of 10 previously reported CT features of complicated appendicitis (contrast enhancement defect of the appendiceal wall, abscess, extraluminal air, intraluminal air, extraluminal appendicolith, intraluminal appendicolith, moderate-to-severe periappendiceal fat stranding, periappendiceal fluid, ileus, and ascites) and rated the likelihood score for complicated appendicitis using gestalt assessment. The sensitivity and specificity of CT for complicated appendicitis were measured by the presence of any of 10 CT features (the any-of-10-features criterion) and by the radiologists gestalt assessment. Pooled sensitivity and specificity were compared using a generalized linear mixed model. RESULTS. The pooled sensitivity of the presence of any of 10 CT features was higher than that of gestalt assessment (92% vs 64%; difference, 28% [95% CI, 10-46%]; p amp;lt; 0.001), although the pooled specificity was lower (43% vs 76%; difference, -33% [95% CI, -48% to -17%]; p amp;lt; 0.001). CONCLUSION. The pooled sensitivity of the presence of any of 10 CT features was higher than that of gestalt assessment, at the cost of lower specificity. For prudent selection of patients who should receive nonoperative treatment of appendicitis, the any-of-10-features criterion may be used to decrease treatment failure associated with a false-negative diagnosis of complication.

Place, publisher, year, edition, pages
AMER ROENTGEN RAY SOC , 2019. Vol. 213, no 5, p. W218-W226
Keywords [en]
appendicitis; conservative treatment; CT; retrospective studies; sensitivity; specificity; x-ray
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:liu:diva-161835DOI: 10.2214/AJR.19.21331ISI: 000492296800004PubMedID: 31414891OAI: oai:DiVA.org:liu-161835DiVA, id: diva2:1370908
Note

Funding Agencies|Guerbet [HI16C0451]; Korea Health Technology R&D Project through the Korea Health Industry Development Institute - Ministry of Health & Welfare, Republic of Korea

Available from: 2019-11-18 Created: 2019-11-18 Last updated: 2019-11-18

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Division of Surgery, Orthopedics and OncologyFaculty of Medicine and Health Sciences
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