Appendicitis: Evaluation of Sensitivity, Specificity, and Predictive Values of US, Doppler US, and Laboratory Findings

Kessler, N; Cyteval, C.; Gallix, Benoĉt; Lesnik, A.; Blayac, Paul-Marie; Jl, Pujol; Bruel, Jean‐Michel; Taourel, Patrice

doi:10.1148/radiol.2302021520

Cited by 237 publications

(152 citation statements)

References 31 publications

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“…However, technical advances in sonography and radiologic expertise have dramatically improved the ability of sonography to visualize the appendix. 16 In our study, we were able to diagnose perforated appendicitis with sonography as well as with CT. In particular, focal wall defects of Koo et al-CT After Sonography for Acute Appendicitis …”

Section: Discussionmentioning

confidence: 71%

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Koo

Kim

Yang

et al. 2013

J of Ultrasound Medicine

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cute appendicitis is the most common condition requiring prompt abdominal surgery to minimize morbidity and mortality. Sonography and computed tomography (CT) have been widely used as the preferred imaging tools in patients with suspected acute appendicitis. 1 In previous studies of these diagnostic techniques, the sensitivities and specificities of sonography were 67% to 88% and 78% to 100%, respectively, whereas the sensitivities and specificities of CT were 76% to 96% and 75% to 95%. [2][3][4][5][6] Hye Soo Koo, MD, Hyun Cheol Kim, MD, Dal Mo Yang, MD, Sang Won Kim, MD, Seong Jin Park, MD, Jung Kyu Ryu, MD Received December 17, 2012, Objectives-The purpose of this study was to evaluate the additional value of supplementary computed tomography (CT) after sonography for diagnosing acute appendicitis.Methods-Among 140 consecutive patients with suspected acute appendicitis who underwent both initial sonography and supplementary CT within 12 hours, 88 patients whose appendices could not be visualized on sonography were excluded. The remaining 52 patients (mean age, 37.3 years; range, 15-98 years) were enrolled in this study. Two radiologists retrospectively reviewed the findings of 52 sonographic and CT examinations, and the appendix of each patient was classified as normal, equivocal appendicitis, nonperforated acute appendicitis, or perforated appendicitis. Causes of right lower quadrant pain other than appendicitis were also recorded. The additional value of supplementary CT was evaluated by performing head-to-head comparisons between CT and sonographic results.Results-No patients with a normal appendix on sonography showed appendicitis on CT. In addition, there were no patients with a sonographic diagnosis of appendicitis who had a normal appendix on CT. Ten patients (19.2%) were determined to have additional value gained from CT. Among these 10 patients, however, the additional information from CT affected treatment modality decisions in only 5.Conclusions-Initial sonography can be as effective as CT in patients with suspected acute appendicitis when the results are definite. Supplementary CT should only be performed when sonography is inconclusive.

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Section: Discussionmentioning

confidence: 71%

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Koo

Kim

Yang

et al. 2013

J of Ultrasound Medicine

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“…It is important to note that the measurement is performed when the appendix is compressed using the graded compression technique to prevent false positives and ensure a degree of repeatability. A normal appendix will compress and be less than 6 mm, while an inflamed appendix is usually both enlarged and importantly, non‐compressible 36. There are conflicting views regarding the significance of the appendiceal diameter, with Kessler et al's36 finding that it is the most accurate predictor.…”

Section: Methodsmentioning

confidence: 99%

“…A normal appendix will compress and be less than 6 mm, while an inflamed appendix is usually both enlarged and importantly, non‐compressible 36. There are conflicting views regarding the significance of the appendiceal diameter, with Kessler et al's36 finding that it is the most accurate predictor. In contrast, Rettenbacher et al48 stated that it should not be used as the sole predictor of appendicitis because the diameter can increase in response to other RLQ inflammation.…”

Section: Methodsmentioning

confidence: 99%

“…3). 36 Similarly, intra‐luminal air is not a reliable indicator of acute appendicitis as it is found in both normal and inflamed appendices and can be easily confused with dirty shadowing from normal faeces or a small appendicolith 36, 46. Measurement of the appendiceal wall has also been used as a potential indicator of appendicitis, but is technically difficult to reliably perform as the inflammation of the mucosa may have a similar hypoechoic appearance to intra‐luminal pus (Fig.…”

Section: Methodsmentioning

confidence: 99%

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Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

Reddan

Corness

Mengersen

et al. 2016

J of Medical Radiation Sci

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Sonography is an important clinical tool in diagnosing appendicitis in children as it can obviate both exposure to potentially harmful ionising radiation from computed tomography scans and the need for unnecessary appendicectomies. This review examines the diagnostic accuracy of ultrasound in the identification of acute appendicitis, with a particular focus on the the utility of secondary sonographic signs as an adjunct or corollary to traditionally examined criteria. These secondary signs can be important in cases where the appendix cannot be identified with ultrasound and a more meaningful finding may be made by incorporating the presence or absence of secondary sonographic signs. There is evidence that integrating these secondary signs into the final ultrasound diagnosis can improve the utility of ultrasound in cases where appendicitis is expected, though there remains some conjecture about whether they play a more important role in negative or positive prediction in the absence of an identifiable appendix.

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“…Eine Übersicht über die Sensitivität und Spezifität diverser sonomorphologischer Zeichen bei Appendizitis (u. a. Durchmesser >6 mm, fehlende Komprimierbarkeit, echoreiche Fettgewebealteration, kein intraluminales Gas, erhöhte Perfusion der Appendixwand, freie intraabdominale Flüssigkeit, Appendikolith) gibt die Arbeit von Kessler et al [7]. …”

Section: Lokale Flüssigkeitsansammlungenunclassified

Beeindruckendes Sonogramm einer Appendizitis

2012

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Appendicitis: Evaluation of Sensitivity, Specificity, and Predictive Values of US, Doppler US, and Laboratory Findings

Abstract: A threshold 6-mm diameter of the appendix under compression is the most accurate US finding for appendicitis and has high NPV and PPV.

Cited by 237 publications

References 31 publications

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Does Computed Tomography Have Any Additional Value After Sonography in Patients With Suspected Acute Appendicitis?

Ultrasound of paediatric appendicitis and its secondary sonographic signs: providing a more meaningful finding

Beeindruckendes Sonogramm einer Appendizitis

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