Document Type : Research articles
Authors
- Hadi Ahmadi Amoli 1
- Abbas Naeej 1
- Neda Nilforoushan 2
- Hossein Zabihi Mahmoudabadi 1
- Ehsan Rahimpour 1
- Amir Ashraf-Ganjouei 2
1 Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 1. Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran 2. Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract
Background: Acute appendicitis is one the most common and sometimes life threatening conditions in the Emergency Department referrals. Since suspected cases of acute appendicitis require immediate diagnosis and proper intervention, the computed tomography (CT) scan becomes the most frequently used modality for such conditions. However, due to the nature of emergency wards, gastrointestinal (GI) expert radiologists may not be always available.
Objectives: The current study aimed at comparing the interobserver variability of GI expert radiologists, general radiologists, and radiology residents in in CT-scan interpretation of cases suspected of acute appendicitis.
Methods: Seventy patients suspected of acute appendicitis admitted to the Emergency Department of our university hospital were included in the study. CT-scan with intravenous contrast was performed on patients that their Alvarado score ranged 5 to 8. Decision for surgical or non-surgical management of patients was made by the routine treatment team of hospital and retrospectively, CTscan
images of all 70 patients were reported blindly by three groups of radiologists.
Results: Out of the 70 cases, 48 had positive confirmatory pathology for appendicitis (69%) and 22 had negative pathology report (31%). The sensitivity of the reports for radiology residents, general radiologists, and GI expert radiologists was 81.3%, 93.8% and 95.8%, respectively. The specificity of the diagnosis in the three groups was 72.7%, 86.4% and 81.8%, respectively.
Conclusions: The study results showed that although the interpretation was not perfect, radiology residents and general radiologists can provide reports with acceptable sensitivity and specificity in the emergency ward.
Keywords
- Hosseini A, Omidian J, Nazarzadeh R. Investigating diagnostic value of ultrasonography in acute appendicitis. Adv Biomed Res. 2018;7:113. doi: 10.4103/abr.abr_79_18. [PubMed: 30123787]. [PubMed Central: PMC6071446].
- Wise SW, Labuski MR, Kasales CJ, Blebea JS, Meilstrup JW, Holley GP, et al. Comparative assessment of CT and sonographic techniques for appendiceal imaging. AJR Am J Roentgenol. 2001;176(4):933-41. doi: 10.2214/ajr.176.4.1760933. [PubMed: 11264081].
- Karul M, Berliner C, Keller S, Tsui TY, Yamamura J. Imaging of appendicitis in adults. Rofo. 2014;186(6):551-8. doi: 10.1055/s-0034-1366074. [PubMed: 24760428].
- Yu YR, Shah SR. Can the diagnosis of appendicitis be made without a computed tomography scan? Adv Surg. 2017;51(1):11-28. doi: 10.1016/j.yasu.2017.03.002. [PubMed: 28797333].
- Patel RR, Javors BR. Intramural vesicular fat--an uncommon CT finding. Clin Imaging. 2012;36(1):75-6. doi: 10.1016/j.clinimag.2011.04.015. [PubMed: 22226449].
- Wi SA, Kim DJ, Cho ES, Kim KA. Diagnostic performance of MRI for pregnant patients with clinically suspected appendicitis. Abdom Radiol (NY). 2018;43(12):3456-61. doi: 10.1007/s00261-018-1654-5. [PubMed: 29869102].
- in't Hof KH, Krestin GP, Steijerberg EW, Bonjer HJ, Lange JF, Becking WB, et al. Interobserver variability in CT scan interpretation for suspected acute appendicitis. Emerg Med J. 2009;26(2):92-4. doi: 10.1136/emj.2008.058990. [PubMed: 19164615].
- Owen TD, Williams H, Stiff G, Jenkinson LR, Rees BI. Evaluation of the Alvarado score in acute appendicitis. J R Soc Med. 1992;85(2):87-8. [PubMed: 1489366]. [PubMed Central: PMC1294889].
- Chong CF, Adi MI, Thien A, Suyoi A, Mackie AJ, Tin AS, et al. Development of the RIPASA score: A new appendicitis scoring system for the diagnosis of acute appendicitis. Singapore Med J. 2010;51(3):220-5. [PubMed: 20428744].
- Kim SY, Lee KH, Kim K, Kim TY, Lee HS, Hwang SS, et al. Acute appendicitis in young adults: Low- versus standard-radiation-dose contrast-enhanced abdominal CT for diagnosis. Radiology. 2011;260(2):437-45. doi: 10.1148/radiol.11102247. [PubMed: 21633052].
- Seo H, Lee KH, Kim HJ, Kim K, Kang SB, Kim SY, et al. Diagnosis of acute appendicitis with sliding slab ray-sum interpretation of low-dose unenhanced CT and standard-dose i.v. contrast-enhanced CT scans. AJR Am J Roentgenol. 2009;193(1):96-105. doi: 10.2214/AJR.08.1237. [PubMed: 19542400].
- Albano MC, Ross GW, Ditchek JJ, Duke GL, Teeger S, Sostman HD, et al. Resident interpretation of emergency CT scans in the evaluation of acute appendicitis. Acad Radiol. 2001;8(9):915-8. doi: 10.1016/s1076-6332(03)80772-9. [PubMed: 11724048].
', './data/ircmj/coversheet/cover_en.jpg'))