Contribution of the Appendix Sphericity Index ın Predicting Perforated Acute Appendicitis

Abstract

BACKGROUND:The purpose of the present study was to investigate the diagnostic value of the appendiceal sphericity index (SI) and appendix diameters in cases of perforated and non-perforated acute appendicitis.METHODS: Eighty-one patients who underwent computed tomography (CT) in our clinic and who were diagnosed with acute appendicitis after histopathological assessment between January 2015 and August 2017 were included in the study. According to their histopathological findings, the patients were divided into two groups: perforated and non-perforated appendicitis. The patients' CT images were re-evaluated with respect to perforation. Long axis and short axis of the appendix and the SI obtained by their proportions were calculated from the appropriate plane on CT. Their parameters and other CT findings as defined in the current literature were analyzed for statistical significance in the detection of perforation. RESULTS:The perforated and non-perforated appendicitis groups consisted of 20 and 61 patients, respectively. For wall defect, abscess, extraluminal air, free fluid, and appendicolith, the sensitivity values were 25%, 15%, 25%, 55%, and 50%, respectively, and the specificity values were 100%, 100%, 100%, 77%, and 70.5%, respectively. Sensitivity and specificity for the SI and long axis of the appendix were calculated as 85% and 90% and 85.2% and 73.8%, respectively (p<0.001). CONCLUSION:Although there are many findings with high specificity in the diagnosis of perforation, their sensitivity is very low when evaluated separately. We consider that the measurement of long-axis length with high sensitivity and the evaluation of SI with high specificity and sensitivity will contribute significantly to the diagnosis of perforation.

Predictive value of sphericity index and other multidetector computed tomography findings in perforated acute appendicitis

“…US is a 75–90% successful imaging method for the diagnosis of acute appendicitis. [ 6 ] However, severe appendicitis and inconclusive ultrasonography are related, according to Pelin et al[ 14 ] Echogenic submucosal layering, local fluid in the pericecal region, and decrease in roundness are valuable US findings in suspicion of perforation. [ 6 ] Borushok et al evaluated a decrease in the roundness of the appendix as the ultrasonographic criterion of perforation, with a sensitivity of 59.1% and a specificity of 67.9%.…”

“…In the evaluation of abdominal CT, appendicolith, appendix long and short axis length (mm), sphericity index, wall defect, periappendicular free fluid, abscess, intraabdominal free air, ileus, and retroperitoneal space (RPS) involvement were examined. ASI was measured and recorded as described by Şirik and İnan[ 6 ] Sphericity index was calculated according to the long axis/short axis ratio in images on the CT plane perpendicular to the appendix ( Fig. 1 and 2 ).…”

“…1 and 2 ). [ 6 ] RPS segments were evaluated for signs of inflammation, such as thickening of the fascial plane. The histopathological result was considered the gold standard for the diagnosis of perforation.…”

“…[ 3 ] Perforated appendicitis can be diagnosed with high specificity with the presence of extraluminal free air, abscess, appendiceal wall defect, or extraluminal appendicolith on CT.[ 4 ] In addition to these, less specific findings such as periappendiceal phlegmon, ileus, ascites, and appendiceal sphericity index (ASI) are reported in the literature. [ 5 , 6 ] On the other hand, there are also authors who argue that perforation cannot be diagnosed by MDCT alone, unless there is an abscess or extraluminal gas. [ 7 ]…”

Incidental Findings on Routine Histopathological Examination: Analysis of Pediatric Appendectomy Specimens

“…Perforasyon, özellikle gecikmiş tanı ve tedavi olması durumunda artmış morbidite ve mortalite ile birliktedir (17) . Appendiks lümeninde artmış luminal sıvı akümülasyonu, inflamasyonu tetikler ve perforasyona yol açar (17) . Perfore apendisit olması tedavi seçiminde önemlidir.…”