Detection of Burst Appendix Increased with MSCT
The January issue of the journal Radiology includes a report which suggests that diagnosis of a perforated appendix was improved with multi-slice CT of the appendiceal wall.
The Japanese research team noted that contrast-enhanced multi slice CT is an acceptable means to detect perforation of the appendix. The team, therefore, collected data from 102 patients that had appendicitis confirmed pathologically and surgically. Each of the patients underwent IV contrast-enhanced multi-detector row helical CT scanning with a four-slice unit 24 hours prior to undergoing surgical excision.
Five findings from the CT exams were evaluated by two different reviewers: abscess, extraluminal air, appendiceal wall enhancement, extraluminal appendicolith, and phlegmon. Study endpoints were accuracy, sensitivity, and specificity of these five factors with respect to a diagnosis of perforated appendix.
Forty patients had a burst appendix. Data collected indicates that MSCT had a 96 percent accuracy rate of correctly identifying a burst appendix the cases based on defects noted in the appendiceal wall. The best detail was provided with the cine mode display of the transverse thin sections procured from imaging.
Accuracy of the study using the appendiceal wall data was 95 percent. Sensitivity and specificity were noted at 96.8 and 96.1 percent, respectively. Abcesses, extraluminal appendicolith, and extraluminal air were not noted in patients with an intact appendix, but these findings were not found to be sensitive, specific, or accurate in detecting perforation.
The research team noted some limitations in the study; minor injuries resulting from surgery may have been misinterpreted as perforations. As well, some perforations may have been missed or occurred between scanning and surgery.
Nevertheless, this small trial may indicate that contrast-enhanced MSCT may be a valuable tool in diagnosing a ruptured appendix. That data may prompt clinicians to operate sooner, as well as reduce morbidity secondary to prevention of infection that frequently follows rupture.
January 31, 2008 Related topics: Imaging, Diagnostic, Surgery, Radiology