Value of additional ultrasound examination in patients with equivocal computed tomography findings of acute appendicitis: Comparison with computed tomography reassessment

Abstract

Objectives: The objective of this study was to find the diagnostic values of additional ultrasound (US) in patients with equivocal computed tomography (CT) findings of acute appendicitis, compared to CT reassessment. Materials and Methods: Patients with equivocal CT findings of acute appendicitis (n = 115), who underwent the US, were included in the study. Two abdominal radiologists reviewed CT scans independently. They analyzed CT findings and made a diagnosis of acute appendicitis. The patients were categorized into positive and negative appendicitis based on the previous US reports. The diagnostic performance, interobserver agreement of CT findings, and appendicitis likelihood were calculated. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US (100%, 92.1%, 79.5%, and 100%, respectively) were higher than those of CT reassessment (reviewer 1: 51.9%, 87.5%, 56.1%, and 85.6%; reviewer 2: 66.7%, 85.2%, 58.1%, and 89.3%, respectively). In the coexistent inflammation group, the sensitivity, specificity, PPV, and NPV of US (reviewer 1: 100%, 98%, 91.5%, and 100%; reviewer 2: 100%, 98%, 87.7%, and 100%, respectively) were higher than those of CT reassessment (reviewer 1: 27.3%, 94.1%, 49.9%, and 85.8%; reviewer 2: 14.3%, 98.0%, 50.5%, and 88.9%, respectively). Conclusion: In patients with equivocal CT findings of acute appendicitis, US shows better diagnostic performance than CT reassessment, and helps differentiate with periappendicitis.

Keywords

• Appendicitis
• appendix
• diagnostic tests
• ultrasonography
• X-ray computed tomography