Objectives: The aim of this study was to evaluate the relationships between the severity of appendicitis as depicted on CT and blood inflammatory markers of serum white blood cell (WBC) count and C-reactive protein (CRP). Methods: CT images in 128 patients (109 surgically proven and 19 with clinically excluded appendicitis) were retrospectively reviewed. Two radiologists by consensus evaluated and scored (using a 0, 1 or 2 point scale) severities based on CT-determined appendiceal diameters, appendiceal wall changes, caecal changes, periappendiceal inflammatory stranding and phlegmon or abscess formation. We investigated whether CT findings were significantly related to elevated WBC counts or CRP levels and performed the correlations of WBC counts and CRP levels with CT severity scores. Patients were also subjectively classified using four grades from normal (Grade I) to perforated appendicitis (Grade IV) on the basis of CT findings to evaluate differences in WBC counts and CRP levels between grades. Results: Only appendiceal wall changes and the phlegmon or abscess formation were related to elevated WBC counts and CRP levels, respectively (p,0.05). CT severity scores were found to be more strongly correlated with CRP levels (r50.669) than with WBC counts (r50.222). On the basis of CT grades, the WBC counts in Grade I were significantly lower than in other grades (p,0.001), whereas CRP levels in Grade IV were significantly higher than in other grades (p,0.001). Conclusion: CRP levels were found to correlate with CT-determined acute appendicitis severity and could be a useful predictor for perforated appendicitis, whereas WBC counts might be useful to detect early acute appendicitis.
Metastasis to the appendix is extremely rare. Moreover, metastasis from a hepatocellular carcinoma (HCC) has not been reported in the English language literature. We report a case of metastasis to the appendix from a HCC in a 50-year-old man who presented with pain in the right lower quadrant of the abdomen, representing acute appendicitis. On CT, a hypervascular mass occupying the lumen of the appendix with distension of the appendiceal tip and surrounding peritoneal seeding of the HCC were observed. This is the first report of CT findings of metastasis to the appendix from a HCC.
The aim of this study was to assess retrospectively the value of adding coronal reformation images to the identification of the normal appendix using 64-slice multidetector CT (MDCT). 200 consecutive healthy adults with no history of abdominal surgery underwent abdominal CT using 64-slice MDCT without oral contrast administration and were enrolled in the study. Two gastrointestinal radiologists first interpreted the axial images only; after a 2-week interval, they then interpreted both the axial and the coronal images while blinded to the first interpretation. The identification of the normal appendix was interpreted using a four-point scale: 1, not identified; 2, identified with low confidence; 3, probably identified; 4, definitely identified. Agreement between the readers was determined with the use of weighted kappa statistics. Differences in confidence ratings for identification of the appendix were determined with the Wilcoxon signed rank test. The agreement between the readers was higher when both axial and coronal images were reviewed (kappa = 0.85) than when only the axial scans images were reviewed (kappa = 0.43). The mean confidence scores for the identification of the normal appendix by the two readers were significantly higher when both the axial and coronal images were reviewed (mean, 3.81+/-0.498 and 3.83+/-0.485 for the two readers, respectively) than when only the axial images were reviewed (mean, 3.27+/-0.819 and 3.47+/-0.856, respectively) (all p<0.01). Therefore, adding coronal reformation images to 64-slice MDCT significantly improves inter-reader agreement and confidence in the identification of the normal appendix.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.