Predictors of Nondiagnostic Ultrasound for Appendicitis

Keller, Christine; Wang, Nancy E.; Imler, Daniel; Vasanawala, Shreyas S.; Bruzoni, Matías; Quinn, James V.

doi:10.1016/j.jemermed.2016.07.101

“…Furthermore, we have focused on determining which patients will be more likely to have an indeterminate US and to apply an MRI‐first strategy to these patients. For example, in patients who are greater than the 85th percentile for body mass index, we recommend that physicians consider using rapid MRI as the initial diagnostic test given the probability of an indeterminate US . CT is used only for patients unable to tolerate the rapid MRI or who have other specific reasons indicating the need for CT.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging Versus Ultrasound as the Initial Imaging Modality for Pediatric and Young Adult Patients With Suspected Appendicitis

Imler

¹

,

Keller

²

,

Sivasankar

³

et al. 2017

Academic Emergency Medicine

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“…Institutions using US regularly have a higher sensitivity, and the sensitivity increases with an increased rate of visualization of the appendix [79 -81]. In addition, patient characteristics (e. g. obesity) may influence the sensitivity of US [82].…”

Section: Comparison Of Us With Others Imaging Methodsmentioning

confidence: 99%

EFSUMB Position Paper: Recommendations for Gastrointestinal Ultrasound (GIUS) in Acute Appendicitis and Diverticulitis

Dirks

¹

,

Calabrese

²

,

Dietrich

³

et al. 2019

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An interdisciplinary task force of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of acute appendicitis and diverticulitis. Based on an extensive literature review, clinical recommendations for these highly common diseases in visceral medicine are presented.In patients with acute appendicitis, preoperative sonography has been established as a routine procedure in most European countries for medical and legal reasons. Routine sonography in these patients may reduce the rate of unnecessary surgery by half. The sensitivity, specificity, and accuracy of ultrasound reach values above 90 % and are equivalent to CT and MRI. However, the high operator dependence may be a problem, for example in point-of-care ultrasound in emergency departments. Structured training programs, quality controls and standardized ultrasound reporting should be increasingly implemented.In the case of suspected acute diverticulitis, “ultrasound first” should also be a basic element in the approach to all patients. Sonography can confirm the diagnosis and allows early risk stratification. As treatment strategies have become less aggressive and more tailored to the stage of diverticulitis, accurate staging has become increasingly important. GIUS and CT have proven to have similar sensitivity and specificity. Especially in cases of uncomplicated diverticulitis, GIUS will be the one and only imaging procedure. CT may work as a backup and has particular advantages for diverticulitis located in the distal sigmoid, inflammation deep in the small pelvis and insufficient ultrasound scanning conditions. This step-up approach (ultrasound first and CT only in case of a negative or inconclusive ultrasound result) has proven to yield the best accuracy.

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“…The use of modern US equipment with tissue harmonics could further improve detection rate, (12) but some factors, such as obesity, growth pattern, echogenicity and location could interfere in the detection on US. (13,14) Several studies evaluated the role of US as screening tool for renal masses. (5,7,8,15) and few studies compared US and CT accuracies, (16,17) but focusing primarily on tumor size.…”

Section: ❚ Resumomentioning

confidence: 99%

“…The use of modern US equipment with tissue harmonics could further improve detection rate, ( 12 ) but some factors, such as obesity, growth pattern, echogenicity and location could interfere in the detection on US. ( 13 , 14 )…”

Section: Introductionmentioning

confidence: 99%