Akut Apandisit Ön Tanısı Olan Hastalarda Sağ Alt Kadrana Kompresyon Uygulanarak Elde Olunan Abdomen Bt Tetkikinin Tanısal Etkinliğinin Değerlendirilmesi

Abstract

In this study, our aim was to determine the diagnostic accuracy of abdominal CT with compression to the right lower quadrant in adults with suspicion of acute appendicitis. We prospectively studied a total of 71 patients (25 M, 46 F; mean age 32.7±13.3, range 18-74) referred for abdominal CT with a presumptive clinical diagnosis of acute appendicitis between July 2012 and September 2013. All patients underwent abdominal US examination before CT. Patients with conditions in which compression was relatively contraindicated, like intestinal obstruction, abdominal aortic aneurysm, hydronephrosis, were excluded from the study. CT exam was performed after administration of intravenous and oral contrast material, during compression of the right lower quadrant with a 1 L saline bag and an elastic belt with velcro strips. CT images were obtained in the venous phase with 2 or 16-detector row CT. Another set of 97 patients (29 M, 68 F; mean age 37.9±13.8, range 18-78) with clinical suspicion of appendicitis who underwent standard abdominal CT without any compression between April 2011 and June 2012, were evaluated as a control group. Outer diameter of appendix, wall thickening and enhancement, periappendiceal inflammatory changes and appendiceal luminal content were assessed for each patient by two radiologists. Final diagnosis was based on pathologic verification and/or definitive diagnosis at discharge. Patients without pathologic proof of appendicitis were excluded from analysis (9 patients in compression group, 6 patients in standard abdomen CT group). In the compression group, 23 patients had a definite diagnosis of acute appendicitis on pathology, while appendix was normal on CT in 39 patients, in all of which the clinical follow-up excluded the admission diagnosis. In the control group where CT was obtained without any compression , 36 patients had a definite diagnosis of acute appendicitis on pathology, while appendix was normal on CT in 55 patients. Among patients with appendicitis in compression-CT, with appendicitis in standard-CT, without appendicitis in compression-CT and without appendicitis in standard-CT median outer diameter of appendix (min-max) were, 10 mm (7-15 mm), 10.5 mm (7.1-17.6 mm), 5 mm (4-7.5 mm) and 6.3 mm (4.8-10.3 mm), respectively. While the diameter of appendix was not significantly different among patients with appendicitis undergoing CT with or without compression, there was a significant difference across the other groups in pairwise comparisons (p<0.01). In patients without appendicitis, filling of contrast material to the appendiceal lumen was statistically higher in compression group when compared to standard abdomen CT group (p<0.01). Abdominal CT with compression to the right lower quadrant, which can be considered as a CT counterpart of graded compression US, has a high diagnostic accuracy in the setting of acute appendicitis.