Predictors of appendicitis on computed tomography among cases with borderline appendix size

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• 作者：Atalie C. Thompson ; Eric W. Olcott ; Peter D. Poullos…
• 关键词：Borderline size appendix ; Appendicitis ; Computed tomography
• 刊名：Emergency Radiology
• 出版年：2015
• 出版时间：August 2015
• 年：2015
• 卷：22
• 期：4
• 页码：385-394
• 全文大小：532 KB
• 参考文献：1.Anderson BA, Salem L, Flum DR (2005) A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. Am J Surg 190(3):474-78. doi:10.-016/?j.?amjsurg.-005.-3.-37 PubMed View Article
  2.Chiu YH, Chen JD, Wang SH, Tiu CM, How CK, Lai JI, Chou YH, Lam C, Chen RJ (2013) Whether intravenous contrast is necessary for CT diagnosis of acute appendicitis in adult ED patients? Acad Radiol 20(1):73-8. doi:10.-016/?j.?acra.-012.-7.-07 PubMed View Article
  3.Lin KH, Leung WS, Wang CP, Chen WK (2008) Cost analysis of management in acute appendicitis with CT scanning under a hospital global budgeting scheme. Emerg Med J 25(3):149-52. doi:10.-136/?emj.-007.-50963 PubMed View Article
  4.Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ (1998) Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 338(3):141-46. doi:10.-056/?NEJM199801153380-01 PubMed View Article
  5.Phillips RL Jr, Bartholomew LA, Dovey SM, Fryer GE Jr, Miyoshi TJ, Green LA (2004) Learning from malpractice claims about negligent, adverse events in primary care in the United States. Qual Saf Health Care 13(2):121-26PubMed Central PubMed View Article
  6.Bendeck SE, Nino-Murcia M, Berry GJ, Jeffrey RB Jr (2002) Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 225(1):131-36. doi:10.-148/?radiol.-251011780 PubMed View Article
  7.Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD (2010) Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med 55(1):51-9. e1. doi:10.-016/?j.?annemergmed.-009.-6.-09 PubMed View Article
  8.Torbati SS, Guss DA (2003) Impact of helical computed tomography on the outcomes of emergency department patients with suspected appendicitis. Acad Emerg Med 10(8):823-29PubMed View Article
  9.Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, Babyn PS, Dick PT (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241(1):83-4. doi:10.-148/?radiol.-411050913 PubMed View Article
  10.Kim K, Rhee JE, Lee CC, Kim KS, Shin JH, Kwak MJ, Kim JH, Suh GJ, Hahn SK, Singer AJ (2008) Impact of helical computed tomography in clinically evident appendicitis. Emerg Med J 25(8):477-81. doi:10.-136/?emj.-006.-44552 PubMed View Article
  11.Tsao KJ, Peter SDS, Valusek PA, Spilde TL, Keckler SJ, Nair A, Ostlie DJ, Holcomb GW (2008) Management of pediatric acute appendicitis in the computed tomographic era. J Surg Res 147(2):221-24. doi:10.-016/?J.?Jss.-008.-3.-04 PubMed Central PubMed View Article
  12.Lewis FR, Holcroft JW, Boey J, Dunphy E (1975) Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg 110(5):677-84PubMed View Article
  13.Balthazar EJ, Rofsky NM, Zucker R (1998) Appendicitis: the impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol 93(5):768-71. doi:10.-111/?j.-572-0241.-998.-22_?a.?x PubMed View Article
  14.Webb EM, Nguyen A, Wang ZJ, Stengel JW, Westphalen AC, Coakley FV (2011) The negative appendectomy rate: who benefits from preoperative CT? AJR Am J Roentgenol 197(4):861-66. doi:10.-214/?AJR.-0.-369 PubMed View Article
  15.Balthazar EJ, Birnbaum BA, Yee J, Megibow AJ, Roshkow J, Gray C (1994) Acute appendicitis: CT and US correlation in 100 patients. Radiology 190(1):31-5PubMed View Article
  16.Balthazar EJ, Megibow AJ, Siegel SE, Birnbaum BA (1991) Appendicitis: prospective evaluation with high-resolution CT. Radiology 180(1):21-4PubMed View Article
  17.Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, Chung EC (2003) The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT. Acta Radiol 44(6):574-82PubMed View Article
  18.Daly CP, Cohan RH, Francis IR, Caoili EM, Ellis JH, Nan B (2005) Incidence of acute appendicitis in patients with equivocal CT findings. AJR Am J Roentgenol 184(6):1813-820. doi:10.-214/?ajr.-84.-.-1841813 PubMed View Article
  19.Duda JB, Lynch ML, Bhatt S, Dogra VS (2012) Computed tomography mimics of acute appendicitis: predictors of appendiceal disease confirmed at pathology. J Clin Imaging Sci 2:73. doi:10.-103/-156-7514.-04306 PubMed Central PubMed View Article
  20.Friedland JA, Siegel MJ (1997) CT appearance of acute appendicitis in childhood. AJR Am J Roentgenol 168(2):439-42. doi:10.-214/?ajr.-68.-.-016223 PubMed View Article
  21.Tamburrini S, Brunetti A, Brown M, Sirlin CB, Casola G (2005) CT appearance of the normal appendix in adults. Eur Radiol 15(10):2096-103. doi:10.-007/?s00330-005-2784-z PubMed View Article
  22.Keyzer C, Knoop C, Van Wettere M, Dehu M, Gosset N, De Maertelaer V, Gevenois PA (2014) Cystic fibrosis: unenhanced CT description of the appendix in asymptomatic adults. AJR Am J
• 作者单位：Atalie C. Thompson (1) (4)
  Eric W. Olcott (2) (3)
  Peter D. Poullos (2)
  R. Brooke Jeffrey (2)
  Matthew O. Thompson (1)
  Jarrett Rosenberg (2)
  Lewis K. Shin (2) (3)
  
  1. Stanford University School of Medicine, 291 Campus Drive, Li Ka Shing Building, Stanford, CA, 94305, USA
  4. 5959 Maple Ave #1358, Dallas, TX, 75235, USA
  2. Department of Radiology, Stanford Hospital, 300 Pasteur Drive H1307 MC 5105, Stanford, CA, 94305, USA
  3. Department of Radiology, VA Palo Alto Health Care System, 3801 Miranda Ave. MC 114, Palo Alto, CA, 94304, USA
  
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Imaging and Radiology
  Emergency Medicine
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1438-1435

文摘

Confident diagnosis of appendicitis when the appendix is borderline (6 to 7?mm) in size can be challenging. This retrospective study assessed computed tomography (CT) findings that are most predictive of appendicitis when the appendix is borderline in diameter. Three radiologists conducted separate, blind retrospective reviews of 105 contrast-enhanced CTs with borderline appendices. Presence or absence of appendicitis was confirmed by chart review of clinical or surgical outcomes. Logistic regression was used to determine the odds ratio (OR) and the receiver operating characteristic for CT features predictive of appendicitis. Absence of intraluminal air (OR--.11, p-lt;-.001), wall hyperemia (OR--.92, p--.002), wall thickening (OR--9.7, p-lt;-.001), and fat stranding (OR--.85, p--.003) were significant findings in univariate logistic regression. Using a multivariate model, we found that the absence of intraluminal air (OR--.04, p--.002) and wall thickening (OR--4.6, p-lt;-.001) remained statistically significant and were unaffected by adjustment for gender and pediatric age. The area under the curve was significantly greater for the multivariate model than the initial, clinical CT impressions (p--.024). The combination of wall thickening and absence of intraluminal air was 92.6?% (95?% CI 75.7-9.1) sensitive and 82.4?% (95?% CI 65.5-3.2) specific for appendicitis. Wall thickening and the absence of intraluminal air are prominent predictors of appendicitis and, if present together, these features may aid in identifying appendicitis on CT when the appendix is borderline in size.