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Atypical appendicitis: diagnostic value of volume-rendered reconstructions obtained with 16-slice multidetector-row CT

Appendiciti atipiche: valore diagnostico delle ricostruzioni in volume rendering ottenute con TC multidetettore a 16 strati

  • Abdominal Radiology / Radiologia Addominale
  • Published:
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Abstract

Purpose

This study was done to assess the possible clinical value of volume-rendered (VR) and curved volume-rendered (cVR) reconstructions obtained from isotropic data in the diagnosis of atypical appendicitis.

Materials and methods

Forty-five patients with suspected acute appendicitis were examined with 16-slice multidetector computed tomography (MDCT) before and after contrast material injection. A diagnosis of atypical appendicitis was made in 33 cases. Two independent blinded radiologists with 2 and 9 years of CT experience assessed the axial scans and 2 months later the VR and cVR reconstructions. The following parameters were considered: presence, location, and wall thickness of the appendix; wall enhancement; distension; periappendiceal fat attenuation; presence of appendicolith; and free air and/or periappendiceal fluid collections. Sensitivity, specificity, and diagnostic accuracy values were calculated for each reader. The concordance between the two radiologists was analysed by using Cohen’s kappa statistic.

Results

Mean sensitivity, specificity and accuracy for the less experienced radiologist were, respectively, 82%, 91% and 84% for the axial scans and 94%, 91% and 93% for the VR and cVR images, whereas the values for the more experienced reader were 94%, 100% and 95% for axial scans, and 97%, 100% and 98% for VR and cVR images.

Conclusions

In patients with atypical appendicitis, VR and cVR reconstructions increase the accuracy of MDCT in relation to the reader’s experience and reduce the number of false negative results.

Riassunto

Obiettivo

Scopo di questo studio è ricercare eventuali vantaggi delle ricostruzioni volume rendering (VR) e volume rendering curve (VRC) ottenute da dati isotropici nella diagnosi di appendicite atipica.

Materiali e metodi

Quarantacinque pazienti con quadro clinico dubbio per appendicite acuta sono stati esaminati con tomografia computerizzata multidetettore (TCMD) a 16 strati, prima e dopo iniezione di mezzo di contrasto. La diagnosi di appendicite atipica è stata stabilita in 33 pazienti. Due radiologi in cieco e con 2 e 9 anni di esperienza in tomografia computerizzata (TC) hanno valutato le immagini assiali e, a distanza di due mesi, le ricostruzioni VR e VRC. Sono stati esaminati: presenza, sede e spessore parietale dell’appendice, enhancement parietale e distensione del lume, morfologia del grasso periappendicolare, presenza di appendicolita, aria libera e/o raccolte fluide periappendicolari. Valori di sensibilità, specificità e accuratezza diagnostica sono stati calcolati per ciascun lettore, con concordanza analizzata mediante kappa di Cohen.

Risultati

I valori di sensibilità, specificità e accuratezza per il radiologo meno esperto sono stati rispettivamente del 82%, 91% e 84% per le immagini assiali e 94%, 91% e 93% per le VR e VRC, mentre per il radiologo più esperto rispettivamente del 94%, 100% e 95% per le scansioni assiali e 97%, 100% e 98% per quelle ricostruite.

Conclusioni

Nei pazienti con appendicite atipica le ricostruzioni VR e VRC migliorano l’accuratezza della TCMD in relazione all’esperienza dell’operatore e riducono il numero di falsi negativi.

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Authors and Affiliations

  1. Di.M.I.M.P. — Sezione di Diagnostica per Immagini, Policlinico Universitario, Piazza Giulio Cesare 11, 70124, Bari, Italy

    A. A. Stabile Ianora, M. Moschetta & A. Scardapane

  2. Ospedale “San Paolo” Bari — Dipartimento di Radiologia, Via Caposcardicchio 10, 70100, Bari, Italy

    V. Lorusso

Authors
  1. A. A. Stabile Ianora
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  2. M. Moschetta
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  3. V. Lorusso
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  4. A. Scardapane
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Correspondence to A. A. Stabile Ianora.

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Stabile Ianora, A.A., Moschetta, M., Lorusso, V. et al. Atypical appendicitis: diagnostic value of volume-rendered reconstructions obtained with 16-slice multidetector-row CT. Radiol med 115, 93–104 (2010). https://doi.org/10.1007/s11547-009-0450-2

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  • DOI: https://doi.org/10.1007/s11547-009-0450-2

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