Evaluation of Ultrasound Accuracy in Acute Appendicitis Diagnosis

Abstract

Acute appendicitis it a quite common abdominal disorder and considered as a difficult diagnosis. An accurate diagnosis is essential to prevent any complication from delayed surgical intervention. Aim: To evaluate the diagnostic accuracy of ultrasound in acute appendicitis cases in Saudi Arabia compared with histopathology. Moreover, to determine whether there is a correlation between the accuracy of ultrasound in acute appendicitis and the sonographers’ expertise. Methods: A retrospective study was conducted, including patients who admitted to the emergency room with clinical symptoms of suspected acute appendicitis and underwent ultrasound examinations. Diagnostic features, including diameter of the appendix ≥7 mm, free fluid, lack of compressibility, no appendix seen, normal appearance, and thick wall, were recorded for each patient. Results: Only 61 of the 132 patients in the study were accurately diagnosed with the use of ultrasound. Just 44 of them were diagnosed with appendicitis (true positives) and 17 without appendicitis (true negatives). However, 69 patients who had positive histopathologic results received a negative ultrasound diagnosis (false negatives), and 2 patients with negative histopathologic findings had a positive ultrasound diagnosis (false positives). There was no significant association between the accuracy of the ultrasound diagnosis and the years of experience of the sonographers. Conclusion: a low level of diagnostic accuracy was demonstrated when utilizing ultrasound to diagnose cases of acute appendicitis. In addition, no association was found between the years of experience of the sonographer conducting the examination and the diagnosis of acute appendicitis.

Comparison of Ultrasound and Computed Tomography Scanning Accuracy in Diagnosing Acute Appendicitis at King Abdulaziz University Hospital

“…Ahmed and co-workers (2016) also demonstrated comparable findings with a US accuracy of 84%, sensitivity of 86%, and specificity of 80% [10]. On the other hand, Alelyani and co-workers (2021) reported some inconsistent trends in which the US accuracy and sensitivity are relatively lower at 46.2% and 38.9%, respectively, but with a specificity of 89.5% [15].…”

Imaging of Gastrointestinal Tract Ailments

“…The authors concluded that not only can ultrasonography image all inflamed appendices but also can predict the severity of disease with high sensitivity. On the other hand, cases of acute appendicitis diagnosed using ultrasound showed a low diagnostic accuracy in other retrospective studies[156,157]. Interestingly, the diagnostic specificity of ultrasound for appendicitis appears to be contradictory, with some studies demonstrating high specificity ranging from 90% to 100% in differentiating perforated from non-perforated appendicitis in children[158], while others reported lower specificity values (33.33%) in a mixed population of adults(25) and children(47) [157].…”