Diagnosis of Acute Appendicitis With Sliding Slab Ray-Sum Interpretation of Low-Dose Unenhanced CT and Standard-Dose IV Contrast-Enhanced CT Scans

Seo, Hyobin; Lee, Kyung Ho; Kim, Hyuk Jung; Kim, Kyuseok; Kang, Sung-Bum; Kim, So Yeon; Kim, Young Hoon

doi:10.2214/ajr.08.1237

Cited by 81 publications

(53 citation statements)

References 50 publications

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“…Second, the examinations were performed without any oral or IV contrast but several studies have reported high diagnostic performance with unenhanced CT as compared with enhanced CT, even for alternative diseases [16,[18][19][20]. Third, our patient pool was rather small, but even with this group, we detected statistically significant differences between coverages, in particular between pelvic focused coverage and our two other coverages.…”

Section: Discussionmentioning

confidence: 77%

“…We did not use weight-specific tube current products since the relationship between body size parameters for individual dose adaptation in body CT of adults had not been implemented in our clinical routine at that time [17]. None of the patients received oral, rectal or IV contrast material, such protocol yielding high diagnostic performance even for alternative diseases as compared with enhanced CT [16,[18][19][20]. From the raw data of the acquisition, 3-mm-thick axial sections were reconstructed with a 1.5 mm increment.…”

Section: Ct Examinationsmentioning

confidence: 99%

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Optimisedz-axis coverage at multidetector-row CT in adults suspected of acute appendicitis

Brassart

Winant²,

Tack³

et al. 2013

BJR

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Objective: To compare diagnostic performances of two reduced z-axis coverages to full coverage of the abdomen and pelvis for the diagnosis of acute appendicitis and alternative diseases at unenhanced CT. Methods: This study included 152 adults suspected of appendicitis who were enrolled in two ethical committeeapproved previous prospective trials. Based on scans covering the entire abdomen and pelvis (set L), two additional sets of images were generated, each with reduced z-axis coverages: (1) from the top of the iliac crests to the pubis (set S) and (2) from the diaphragmatic crus to the pubis (set M). Two readers independently coded the visualisation of the appendix, measured its diameter and proposed a diagnosis (appendicitis or alternative). Final diagnosis was based on surgical findings or clinical follow-up. Fisher exact and McNemar tests and logistic regression were used.Results: 46 patients had a definite diagnosis of appendicitis and 53 of alternative diseases. The frequency of appendix visualisation was lower for set S than set L for both readers (89% and 84% vs 95% and 91% by Readers A and B, respectively; p50.021 and 0.022). The probability of giving a correct diagnosis was lower for set S (68%) than set L (78%; odds ratio, 0.611; p50.008) for both readers, without significant difference between sets L and M (77%, p50.771); z-axis coverage being reduced by 25% for set M. Conclusion: Coverage from diaphragmatic crus to pubis, but not focused on pelvis only, can be recommended in adults suspected of appendicitis. Advances in knowledge: In suspected appendicitis, CT-coverage can be reduced from diaphragmatic crus to pubis.

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Section: Discussionmentioning

confidence: 77%

Section: Ct Examinationsmentioning

confidence: 99%

Optimisedz-axis coverage at multidetector-row CT in adults suspected of acute appendicitis

Brassart

Winant²,

Tack³

et al. 2013

BJR

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“…Acute appendicitis was histopathologically verified in 37.9 % of the patients in group 1 and in 40.8 % in group 2. The rate of unnecessary appendectomies after low-dose CT was 3.5 % (6/172 patients) and 3.2 % (6/186 patients) after standard-dose CT. Seo et al demonstrated that low-dose CT even without contrast agent is equivalent to standard-dose CT after intravenous contrast agent application [30]. They examined 207 adults with clinical suspicion of appendicitis.…”

Section: Resultsmentioning

confidence: 99%

Imaging of Appendicitis in Adults

Karul

Berliner

Keller

et al. 2014

Fortschr Röntgenstr

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Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2?mm, cross-sectional diameter greater than 6?mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance. Key Points: ??US is the basic diagnostic method in case of suspected appendicitis. ??CT is necessary in patients with atypical presentation of appendicitis. ??MRI should be the first-line imaging test in pregnant women. Citation Format: ??Karul M, Berliner C, Keller S et?al. Imaging of Appendicitis in Adults. Fortschr R?ntgenstr 2014; 186: 551???558

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“…This concern can now be overcome by the use of low-dose CT protocols, which deliver a dose of radiation close to that of an AR. These low-dose CT protocols have been reported to be accurate for the screening of well defined medical conditions, such as renal colic (12) and appendicitis (13)(14)(15) and have also been recently reported a useful in demonstrating the presence of an intracorporeal drug packet (16,17).…”

Section: Introductionmentioning

confidence: 99%

Screening of Illegal Intracorporeal Containers (“Body Packing”): Is Abdominal Radiography Sufficiently Accurate? A Comparative Study with Low-Dose CT

Poletti¹,

Canel²,

Becker³

et al. 2012

Radiology

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Advances in knowledge:1) Abdominal radiography (AR) achieves a limited sensitivity (77%) for the screening of illegal intra-corporeal containers when compared to low-dose CT 2) Illegal intra-corporeal packets are difficult to detect by AR when they are in small number (< 12) 3) The sensitivity of AR for detection of illegal intra-corporeal containers is lower (50%) when they appear iso-dense to the bowel content at low-dose CT than when they appear denser (89%). Implications for patient care:Performing low-dose CT instead of AR will improve the detection of illegal intra-corporeal packets, without increasing the radiation dose. Summary statement:The use of low-dose CT may constitute a reasonable alternative to abdominal radiography to improve the detection of illegal intra-abdominal packets 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 Abstract Purpose: To evaluate the diagnostic performance of the abdominal radiography (AR) to a low-dose CT (LDCT) in the detection of illegal intra-corporeal containers ("packets") using LDCT as a reference standard. Materials and Methods:This study was approved by the institutional ethical review board ; a written informed consent was required (CER 06-023).330 consecutive persons, suspected of having ingested drug packets, underwent a supine AR. The presence or absence of packets at AR were reported and compared to the result of LDCT , considered reference standard. The density and the number of packets (<12 or above) at LDCT were recorded and analyzed to determine if they may influence the AR interpretation. Results:Packets were detected at LDCT in 53 (16%) suspects. The sensitivity of AR for depiction of packets was 77% (41/53), the specificity 96% (267/277). The packets appeared iso-dense to the bowel contents on LDCT in sixteen (30%) of the 53 positive cases. Nineteen (36%) of the 53 positive LDCT displayed fewer than 12 packets. Iso-dense packets on LDCT and having a low number of packets (<12) were both significantly associated with false negative AR exams.Conclusion: AR is mainly limited by a low sensitivity when compared to LDCT for the screening of persons suspected of carrying drug packets. LDCT constitutes an efficient imaging alternative to AR.

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Diagnosis of Acute Appendicitis With Sliding Slab Ray-Sum Interpretation of Low-Dose Unenhanced CT and Standard-Dose IV Contrast-Enhanced CT Scans

Abstract: Low-dose unenhanced CT is potentially useful in the diagnosis of appendicitis.

Cited by 81 publications

References 50 publications

Optimisedz-axis coverage at multidetector-row CT in adults suspected of acute appendicitis

Optimisedz-axis coverage at multidetector-row CT in adults suspected of acute appendicitis

Imaging of Appendicitis in Adults

Screening of Illegal Intracorporeal Containers (“Body Packing”): Is Abdominal Radiography Sufficiently Accurate? A Comparative Study with Low-Dose CT

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