Atypical appendicitis: diagnostic value of volume-rendered reconstructions obtained with 16-slice multidetector-row CT

Ianora, Amato Antonio Stabile; Moschetta, Marco; Lorusso, Vito; Scardapane, Arnaldo

doi:10.1007/s11547-009-0450-2

Cited by 9 publications

(6 citation statements)

References 25 publications

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“…When grouped by modality, there were nine articles on US, composed of six articles on 548 children (9,11,(32)(33)(34)(35) and three articles on 169 adults (36)(37)(38); 20 articles on CT, composed of nine articles on 1498 children (9,26,(39)(40)(41)(42)(43)(44)(45) and 11 articles on 1027 adults (25,37,(46)(47)(48)(49)(50)(51)(52)(53)(54); and 11 articles on MRI, composed of five articles on 287 children (39,(55)(56)(57)(58), one article on 223 adults (59), and five articles on 204 pregnant women (for a total of 427 patients) (24,(60)(61)(62)(63). Figure 1 shows the article selection process.…”

Section: Literature Search and Article Selectionmentioning

confidence: 99%

Acute Appendicitis: A Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US

Eng¹,

Abadeh

Ligocki³

et al. 2018

Radiology

102

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Purpose To evaluate the sensitivity, specificity, and diagnostic odds ratios of US, CT, and MRI as second-line imaging modalities after initial US for assessing acute appendicitis in children and adults. Materials and Methods A literature search was conducted in Medline and Embase to identify articles that used surgery or histopathologic examination alone or in combination with clinical follow-up or chart review to evaluate the diagnostic accuracy of second-line imaging modalities. The quality of articles was assessed by using the Quality Assessment of Diagnostic Accuracy Studies-2 and the Standards for Reporting of Diagnostic Accuracy tools. Results For studies of children, the number of studies and patients were as follows: US, six studies and 548 patients; CT, nine studies and 1498 patients; MRI, five studies and 287 patients. For studies of adults, the number of studies and patients were as follows: US, three studies and 169 patients; CT, 11 studies and 1027 patients; MRI, six studies and 427 patients. Pooled sensitivities and specificities of second-line US for diagnosis of appendicitis in children were 91.3% (95% confidence interval [CI]: 83.8%, 95.5%) and 95.2% (95% CI: 91.8%, 97.3%), respectively; and in adults, the pooled sensitivities and specificities were 83.1% (95% CI: 70.3%, 91.1%) and 90.9% (95% CI: 59.3%, 98.6%), respectively. Regarding second-line CT in children, the pooled sensitivities and specificities were 96.2% (95% CI: 93.2%, 97.8%) and 94.6% (95% CI: 92.8%, 95.9%); and in adults, the pooled sensitivities and specificities were 89.9% (95% CI: 85.4%, 93.2%) and 93.6% (95% CI: 91.2%, 95.3%), respectively. Regarding second-line MRI in children, pooled sensitivities and specificities were 97.4% (95% CI: 85.8%, 100%) and 97.1% (95% CI: 92.1%, 99.0%); and in adults, the pooled sensitivities and specificities were 89.9% (95% CI: 84.8%, 93.5%) and 93.6% (95% CI: 90.9%, 95.5%), respectively. Conclusion Second-line US, CT, and MRI have comparable and high accuracy in helping to diagnose appendicitis in children and adults, including pregnant women. All three modalities may be valid as second-line imaging in a clinical imaging pathway for diagnosis and management of appendicitis.

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Section: Literature Search and Article Selectionmentioning

confidence: 99%

Acute Appendicitis: A Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US

Eng¹,

Abadeh

Ligocki³

et al. 2018

Radiology

102

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“…Abdominal CT is superior at demonstrating the atypically located appendix and appendicitis mimickers, such as diverticulitis, neoplasm, epiploic apandigitis, appendiceal mucoceles, and terminal ileitis [4,10]. The previous studies have shown that CT has higher sensitivity and specificity than US (91 and 90%, 78 and 83%, respectively) [8,9,11]. …”

Section: Discussionmentioning

confidence: 99%

“…Some authors suggest that using enteric contrast material is unnecessary, because it does not increase sensitivity or specifity in acute appendicitis diagnosis [9]. Recent advances in CT imaging with multidetector devices, multiplanar reconstructions and volume rendering by using isotropic voxels, have improved the image quality and eased the visualisation of the appendix and inflammation [8]. …”

Section: Discussionmentioning

confidence: 99%

“…Therefore, computed tomography (CT) is needed for further examination. CT imaging plays a crucial role in the rapid and valid diagnosis in such confusing, complicated cases [8,9]. We aimed to review the CT findings of atypically located acute appendicitis with cases, and remind the clinicians and radiologists the importance of early diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Computed Tomography (CT) Findings of a Diagnostic Dilemma: Atypically Located Acute Appendicitis

2016

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SummaryBackgroundAcute appendicitis is an emergent surgically treated disease generally represented by right lower abdominal pain. The most common location of the appendix is descending intraperitoneal. However, it can also show atypical locations such as inguinal canal, femoral canal, subhepatic, retrocecal, intraperitoneal abdominal midline and left side in situs inversus or intestinal malrotation patients. Atypical location can lead to atypical clinical presentations. Ultrasonography is the first choice modality for imaging. However, it can be insufficient for demonstration of the appendix. Therefore, computed tomography (CT) is needed for further examination. We aim to review the CT findings of atypically located acute appendicitis with cases and remind the clinicians and radiologists the importance of the prompt diagnosis.Case ReportWe presented five atypically-located appendix cases, including four with acute appendicitis that presented to our emergency department with acute abdominal pain. Two of the acute appendicitis cases had normal, the other two had elevated white blood cell count, but all of them had elevated CRP. Ultrasonography imaging was performed as a first-line imaging modality. Because of the inconclusive results of both clinical-laboratory findings and ultrasonography, CT imaging was performed. Abdominal CT demonstrated all of the atypically localised appendices successfully, which were left-sided in a malrotated patient, retrocecal, subhepatic, retrocecal ascending, intraperitoneal abdominal midline localised.ConclusıonsAtypically located acute appendicitis can show atypical presentation and result in misdiagnosis. If ultrasonograpgy is inconclusive, we suggest abdominal CT in such confusing, complicated cases, because misdiagnosis or delay in the right diagnosis can result in complications and increased morbidity and mortality rates.

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“…These patients usually present with moderate abdominal pain that does not worsen or shift. Atypical clinical presentation of appendicitis is more frequent in certain patient groups (elderly, pregnant women, and particularly in patients with anatomical variations of the vermiform appendix relative to the cecum) and may result in diagnostic confusion, and risk of complication such as appendiceal perforation with abscess formation, peritonitis, and bowel obstruction [4][5][6]. A prompt diagnosis is rewarded by marked decrease in morbidity and mortality [7].…”

Section: Introductionmentioning

confidence: 99%

Computed tomography in adults with atypical clinical presentation of acute appendicitis: comparison of findings with inflammatory serum markers

Karul¹,

Avanesov²,

Schoennagel³

et al. 2013

Gasteroentrol Intest Syst

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Purpose: To evaluate both the potential usefulness of multidetector computed tomography (MDCT) in diagnosis of acute appendicitis (AA) in patients with atypical clinical presentation and to compare findings with C-reactive protein (CRP) and white cell count (WCC). Materials and methods: MDCT images in 69 patients with atypical presentation of AA were retrospectively reviewed by two readers in consensus. Diagnostic accuracy, sensitivity, specificity, positive and negative predictive values (PPV/NPV) were assessed considering histopathological evaluation as reference. Patients with AA were grouped in nonperforated vs perforated and CRP/ WCC were correlated using both Chi-square-test (χ 2 ) and receiver operating characteristic (ROC) curve analysis. Results: 39 patients underwent surgery and AA was confirmed histopathologically in 29/39 cases (74.4%), showing nonperforated AA (n=23, 79.3%) and perforated AA (n=6, 20.7%). In the remaining 10/39 patients (25.6%) diverticulitis of sigmoid colon was diagnosed (n=3); colitis (n=4); cholecystitis (n=3). Among the other 30/69 patients MDCT was either unremarkable (n=18) or differentials were detected (n=12). Diagnostic accuracy in patients with histopathologically confirmed AA was 95.7%, sensitivity was 90.6%, specificity was 93.6%, PPV was 83.0%, and NPV was 89.8%. All MDCT findings but calcified appendicoliths and CRP/WCC correlated statistical significant when AA was confirmed histopathologically (χ 2 =26.2; p<0.001). In contrary to WCC (p=0.11), CRP was significantly higher in patients with perforated AA than nonperforated AA (p<0.01), demonstrating an optimal cut-off value >121.5 mg/L. Conclusion: MDCT is required immediately to rule out perforation in patients with suspected AA despite atypical clinical presentation and a CRP level >121.5 mg/L.

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Atypical appendicitis: diagnostic value of volume-rendered reconstructions obtained with 16-slice multidetector-row CT

Abstract: In patients with atypical appendicitis, VR and cVR reconstructions increase the accuracy of MDCT in relation to the reader's experience and reduce the number of false negative results.

Cited by 9 publications

References 25 publications

Acute Appendicitis: A Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US

Acute Appendicitis: A Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US

Computed Tomography (CT) Findings of a Diagnostic Dilemma: Atypically Located Acute Appendicitis

Computed tomography in adults with atypical clinical presentation of acute appendicitis: comparison of findings with inflammatory serum markers

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