MDCT for Suspected Appendicitis: Effect of Reconstruction Section Thickness on Diagnostic Accuracy, Rate of Appendiceal Visualization, and Reader Confidence Using Axial Images

Johnson, Pamela T.; Horton, Karen M.; Kawamoto, Satomi; Eng, John; Bean, Marchelle J.; Shan, Shannon J.; Fishman, Elliot K.

doi:10.2214/ajr.08.1685

Cited by 29 publications

(8 citation statements)

References 38 publications

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“…In addition, our examinations were reconstructed with thin slice thicknesses and intervals, the appendiceal visualisation rate and the reader confidence in its diagnosis being both increased with slice thicknesses lower than 5 mm [30]. 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].…”

Section: Discussionmentioning

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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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: 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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“…No oral or rectal contrast medium was given for opacification of the bowels. NE-LDCT and CE-SDCT images were reconstructed into axial and coronal sections with 3-mm slice thickness and 3-mm intervals due to improved visualization of the appendix with use of thinner slice reconstruction ( 9 ). All images were anonymized before they were sent to a picture archiving communication system (PACS) for investigation.…”

Section: Methodsmentioning

confidence: 99%

Diagnostic Performance on Low Dose Computed Tomography For Acute Appendicitis Among Attending and Resident Radiologists

Chang

Wong

et al. 2016

Iran J Radiol

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BackgroundLow-dose computed tomography (LDCT) techniques can reduce exposure to radiation. Several previous studies have shown that radiation dose reduction in LDCT does not decrease the diagnostic performance for appendicitis among attending radiologists. But, the LDCT diagnostic performance for acute appendicitis in radiology residents with variable training levels has not been well discussed.ObjectivesTo compare inter-observer and intra-observer differences of diagnostic performance on non-enhanced LDCT (NE-LDCT) and contrast-enhanced standard dose CT (CE-SDCT) for acute appendicitis among attending and resident radiologists.Patients and MethodsThis retrospective study included 101 patients with suspected acute appendicitis who underwent NE-LDCT and CE-SDCT. The CT examinations were interpreted and recorded on a five-point scale independently by three attending radiologists and three residents with 4, 1 and 1 years of training. Diagnostic performance for acute appendicitis of all readers on both examinations was represented by area under receiver operating characteristic (ROC) curves. Inter-observer and intra-observer AUC values were compared using Jackknife FROC software on both modalities. The diagnostic accuracy of each reader on NE-LDCT was compared with body mass index (BMI) subgroups and noise using independent T test.ResultsDiagnostic performances for acute appendicitis were not statistically different for attending radiologists at both examinations. Better performance was noted on the CE-SDCT with a borderline significant difference (P = 0.05) for senior radiology resident. No statistical difference of AUC values was observed between attending radiologists and fourth year resident on both examinations. Statistically signiﬁcant differences of AUC values were observed between attending radiologists and first year residents (P = 0.001 ~ 0.018) on NE-LDCT. Diagnostic accuracies of acute appendicitis on NE-LDCT for each reader were not significantly related to BMI or noise.ConclusionAttending radiologists could diagnose acute appendicitis accurately on NE-LDCT. Performance of senior residents on NE-LDCT is better than junior residents and comparable to attending radiologists.

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“…In the case of the appendix, the impact of slice thickness on several factors, including visualization of the appendix, confidence in appendiceal visualization, diagnostic accuracy, and diagnostic confidence in diagnosing appendicitis has been reported for varying CT slice thicknesses. 23 The authors found that the correctness of the diagnosis of appendicitis was not affected by slice thickness using 3 techniques (5 Â 5 mm, 3 Â 3 mm, and 2 Â 1 mm; thickness and interval). However, progressively thinner section thickness was found to be associated with significant increases in the rate of appendiceal visualization and appendiceal visualization confidence.…”

Section: Image Reconstruction and Post-processingmentioning

confidence: 98%

Multi-Detector Row CT of Acute Non-traumatic Abdominal Pain: Contrast and Protocol Considerations

Anderson

Soto

2012

Radiologic Clinics of North America

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MDCT for Suspected Appendicitis: Effect of Reconstruction Section Thickness on Diagnostic Accuracy, Rate of Appendiceal Visualization, and Reader Confidence Using Axial Images

Abstract: In this investigation of contrast-enhanced MDCT of the appendix, visual ization of the appendix and confidence in interpretation of axial images progressively improved with use of thinner reconstruction sections.

Cited by 29 publications

References 38 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

Diagnostic Performance on Low Dose Computed Tomography For Acute Appendicitis Among Attending and Resident Radiologists

Multi-Detector Row CT of Acute Non-traumatic Abdominal Pain: Contrast and Protocol Considerations

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