Korean Journal of Radiology

  • 제17권1호
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  • Pages.39-46
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  • 2016
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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Intra-Appendiceal Air at CT: Is It a Useful or a Confusing Sign for the Diagnosis of Acute Appendicitis?

  • Hong, Hye-Suk (Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Cho, Hyun Suk (Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Woo, Ji Young (Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Lee, Yul (Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Yang, Ik (Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Hwang, Ji-Young (Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Han Myun (Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine) ;
  • Kim, Jeong Won (Department of Pathology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine)
  • 투고 : 2015.08.28
  • 심사 : 2015.10.02
  • 발행 : 2016.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To investigate the significance of intra-appendiceal air at CT for the evaluation of appendicitis. Materials and Methods: We retrospectively analyzed 458 patients (216 men, 242 women; age range, 18-91 years) who underwent CT for suspected appendicitis. Two independent readers reviewed the CT. Prevalence, amount, and appearance of intra-appendiceal air were assessed and compared between the patients with and without appendicitis. Performance of CT diagnosis was evaluated in two reading strategies: once ignoring appendiceal air (strategy 1), and the other time considering presence of appendiceal air as indicative of no appendicitis in otherwise indeterminate cases (strategy 2), using receiver operating characteristic (ROC) analysis. Results: Of the 458 patients, 102 had confirmed appendicitis. The prevalence of intra-appendiceal air was significantly different between patients with (13.2%) and without (79.8%) appendicitis (p < 0.001). The amount of appendiceal air was significantly lesser in patients having appendicitis as compared with the normal group, for both reader 1 (p = 0.011) and reader 2 (p = 0.002). Stool-like appearance and air-fluid levels were more common in the appendicitis group than in the normal appendix for both readers (p < 0.05). Areas under the ROC curves were not significantly different between strategies 1 and 2 in reader 1 (0.971 vs. 0.985, respectively; p = 0.056), but showed a small difference in reader 2 (0.969 vs. 0.986, respectively; p = 0.042). Conclusion: Although significant differences were seen in the prevalence, amount, and appearance of intra-appendiceal air between patients with and without appendicitis, it has a limited incremental value for the diagnosis of acute appendicitis.

키워드

참고문헌

  1. Rao PM, Rhea JT, Novelline RA, Mostafavi AA, McCabe CJ. Effect of computed tomography of the appendix on treatment of patients and use of hospital resources. N Engl J Med 1998;338:141-146 https://doi.org/10.1056/NEJM199801153380301
  2. Jacobs JE, Balthazar EJ. Diseases of the appendix. In: Gore RM, Levine MS, eds. Textbook of gastrointestinal radiology. 3rd ed. Philadelphia, PA: Saunders, 2008:1039-1069
  3. Pickhardt PJ, Lawrence EM, Pooler BD, Bruce RJ. Diagnostic performance of multidetector computed tomography for suspected acute appendicitis. Ann Intern Med 2011;154:789-796, W-291 https://doi.org/10.7326/0003-4819-154-12-201106210-00006
  4. Birnbaum BA, Wilson SR. Appendicitis at the millennium. Radiology 2000;215:337-348 https://doi.org/10.1148/radiology.215.2.r00ma24337
  5. Pinto Leite N, Pereira JM, Cunha R, Pinto P, Sirlin C. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol 2005;185:406-417 https://doi.org/10.2214/ajr.185.2.01850406
  6. van Randen A, Lameris W, van Es HW, ten Hove W, Bouma WH, van Leeuwen MS, et al. Profiles of US and CT imaging features with a high probability of appendicitis. Eur Radiol 2010;20:1657-1666 https://doi.org/10.1007/s00330-009-1706-x
  7. Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, et al. The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT. Acta Radiol 2003;44:574-582 https://doi.org/10.1046/j.1600-0455.2003.00146.x
  8. Bixby SD, Lucey BC, Soto JA, Theysohn JM, Ozonoff A, Varghese JC. Perforated versus nonperforated acute appendicitis: accuracy of multidetector CT detection. Radiology 2006;241:780-786 https://doi.org/10.1148/radiol.2413051896
  9. Callahan MJ, Rodriguez DP, Taylor GA. CT of appendicitis in children. Radiology 2002;224:325-332 https://doi.org/10.1148/radiol.2242010998
  10. Rettenbacher T, Hollerweger A, Macheiner P, Rettenbacher L, Frass R, Schneider B, et al. Presence or absence of gas in the appendix: additional criteria to rule out or confirm acute appendicitis--evaluation with US. Radiology 2000;214:183-187 https://doi.org/10.1148/radiology.214.1.r00ja20183
  11. Tamburrini S, Brunetti A, Brown M, Sirlin CB, Casola G. CT appearance of the normal appendix in adults. Eur Radiol 2005;15:2096-2103 https://doi.org/10.1007/s00330-005-2784-z
  12. Webb EM, Wang ZJ, Coakley FV, Poder L, Westphalen AC, Yeh BM. The equivocal appendix at CT: prevalence in a control population. Emerg Radiol 2010;17:57-61 https://doi.org/10.1007/s10140-009-0826-6
  13. Kim HC, Yang DM, Kim SW, Park SJ. Reassessment of CT images to improve diagnostic accuracy in patients with suspected acute appendicitis and an equivocal preoperative CT interpretation. Eur Radiol 2012;22:1178-1185 https://doi.org/10.1007/s00330-011-2362-5
  14. Azok JT, Kim DH, Munoz Del Rio A, Sonavane SK, Bhalla S, Anaya-Baez V, et al. Intraluminal air within an obstructed appendix: a CT sign of perforated or necrotic appendicitis. Acad Radiol 2012;19:1175-1180 https://doi.org/10.1016/j.acra.2012.04.018
  15. Kim K, Kim YH, Kim SY, Kim S, Lee YJ, Kim KP, et al. Lowdose abdominal CT for evaluating suspected appendicitis. N Engl J Med 2012;366:1596-1605 https://doi.org/10.1056/NEJMoa1110734
  16. Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull 1968;70:213-220 https://doi.org/10.1037/h0026256
  17. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977;33:159-174 https://doi.org/10.2307/2529310
  18. Rao PM, Rhea JT, Novelline RA. Appendiceal and periappendiceal air at CT: prevalence, appearance and clinical significance. Clin Radiol 1997;52:750-754 https://doi.org/10.1016/S0009-9260(97)80153-5
  19. Clarke PD. Computed tomography of gangrenous appendicitis. J Comput Assist Tomogr 1987;11:1081-1082 https://doi.org/10.1097/00004728-198711000-00036
  20. Killen DA, Brooks DW Jr. Gas-filled appendix: a roentgenographic sign of acute appendicitis. Ann Surg 1965;161:474-478 https://doi.org/10.1097/00000658-196503000-00023
  21. Rao PM, Rhea JT, Novelline RA. Distal appendicitis: CT appearance and diagnosis. Radiology 1997;204:709-712 https://doi.org/10.1148/radiology.204.3.9280247
  22. Cabarrus M, Sun YL, Courtier JL, Stengel JW, Coakley FV, Webb EM. The prevalence and patterns of intraluminal air in acute appendicitis at CT. Emerg Radiol 2013;20:51-56 https://doi.org/10.1007/s10140-012-1076-6
  23. Rao PM. Technical and interpretative pitfalls of appendiceal CT imaging. AJR Am J Roentgenol 1998;171:419-425 https://doi.org/10.2214/ajr.171.2.9694467
  24. Levine CD, Aizenstein O, Wachsberg RH. Pitfalls in the CT diagnosis of appendicitis. Br J Radiol 2004;77:792-799 https://doi.org/10.1259/bjr/95663370
  25. Kim SY, Lee KH, Kim K, Kim TY, Lee HS, Hwang SS, et al. Acute appendicitis in young adults: low- versus standardradiation-dose contrast-enhanced abdominal CT for diagnosis. Radiology 2011;260:437-445 https://doi.org/10.1148/radiol.11102247
  26. Ganguli S, Raptopoulos V, Komlos F, Siewert B, Kruskal JB. Right lower quadrant pain: value of the nonvisualized appendix in patients at multidetector CT. Radiology 2006;241:175-180 https://doi.org/10.1148/radiol.2411050191

피인용 문헌

  1. RE: Temporal Changes of Intra-Appendiceal Air at CT in the Diagnosis of Acute Appendicitis vol.17, pp.4, 2016, https://doi.org/10.3348/kjr.2016.17.4.562
  2. Selection and Reporting of Statistical Methods to Assess Reliability of a Diagnostic Test: Conformity to Recommended Methods in a Peer-Reviewed Journal vol.18, pp.6, 2017, https://doi.org/10.3348/kjr.2017.18.6.888
  3. How to differentiate acute pelvic inflammatory disease from acute appendicitis ? A decision tree based on CT findings vol.28, pp.2, 2016, https://doi.org/10.1007/s00330-017-5032-4