Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria.

Abstract

Four sonographic diagnostic criteria for appendicitis, (1) any visualization, (2) appendiceal diameter greater than 6.0 mm, (3) muscular wall thickness greater than or equal to 3.0 mm, and (4) presence of a complex mass, were compared in a series of 200 patients clinically suspected of having appendicitis. The diagnosis of appendicitis was confirmed histopathologically and included all forms of appendicitis with mucosal invasion by inflammatory cells. The sensitivities of all the criteria were low (11% to 75%) and the usefulness of this test as a screening procedure is questioned. The combined criteria of an appendix with a muscular wall thickness (MWT) greater than or equal to 3.0 mm and visualization of a complex mass (CM) separate from the adnexa in females proved most useful as a diagnostic test (sensitivity, 68%; specificity, 98%). We conclude that the diagnosis of appendicitis is still difficult, despite the addition of graded compression ultrasound as a diagnostic test. We do not recommend its use as the only screening test, but do recommend it, rather, in a diagnostic role after the initial clinical screening.

Development and validation of an ultrasound scoring system for children with suspected acute appendicitis

“…We evaluated the diagnostic performance of the size of the appendix using a receiver operator curve (Fig. 4) and found that a size threshold of 7.5 mm provided the best balance between sensitivity and specificity, which is slightly higher than our initial size threshold of 6.0 mm [4,5].…”

Accuracy of Noncompressive Sonography of Children with Appendicitis According to the Potential Positions of the Appendix

“…Since then, this technique has become standard in studies of sonographic investigation of acute appendicitis, and high levels of sensitivity and specificity have been achieved in the diagnosis of this disease [5][6][7][8][9][10][11]. Although several authors report that compression at sonography is usually well tolerated [12,13] for children who have rebound tenderness with appendicitis, gentle percussion is recommended even at physical examination to make the examination less painful [14].…”

US diagnosis of acute appendicitis

“…4 In most of the cases that valorize the contribution of US into the diagnosis of the acute appendicitis the sensitivity is from 75-90%, and specificity is from 86-100% and the diagnostic accuracy is from 87-96%. 1,3,6,7,14,15 Most of the newly publications demonstrated that the greatest diameter of the appendix is >6mm, there is about inflammation in 93% of the cases.…”

“…In 30% of the cases the appendix could be hidden from the anterior peritoneum due to its pelvic or retro colic location. 6 The poster lateral approach is better for the exploration of the retrocecal region.…”

“…With use of US and CT and with use of the established criteria the timely and accurate diagnosis is made up with reduction of the number of the unnecessary surgery and the number of appendiceal perforation as well. [5][6][7][8] …”