비전형적인 증상을 가진 급성 충수염 의심환자의 진단에서 복부 컴퓨터 단층촬영의 역할
The Role of Computed Tomography in the Diagnosis of Acute Appendicitis
최인석, 예병국, 한군택, 심문섭,
소속 상세정보
최인석 ( Choi In-Seok )
부산대학교 의과대학 외과학교실
예병국 ( Yea Byung-Kook )
부산대학교 의과대학 외과학교실
한군택 ( Han Koon-Taek )
부산대학교 의과대학 외과학교실
심문섭 ( Sim Mun-Sup )
부산대학교 의과대학 외과학교실
KMID : 0356720020180030178
Abstract
Purpose: Appendicitis represents one of the most common surgical disorders. Typically, the diagnosis can be made from well established clinical criteria, with an acceptable negative appendectomy rate from 7∼25%. However, when surgical intervention is performed in the patients suspected of having appendicitis but with equivocal clinical findings, the negative appendectomy rate approaches 50%. Routine contrast-enhanced computed tomography (CECT) has described as an accurate diagnostic imaging modality in patients with suspected appendicitis. We evaluated the role of intravenous CECT (iCECT) in patients suspected of having appendicitis but with equivocal clinical exams.
Methods: Eighty seven consecutive patients who were thought to have appendicitis but with equivocal clinical findings and/or physical exams were imaged by iCECT over 18 months period. Intravenous contrast-enhanced, spiral abdominal and pelvic images were obtained using 7.5 ㎜ cuts. iCECT images were interpreted by a board-certified radiologist. Main outcome measures included iCECT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accurary and negative appendectomy rate in the diagnosis of acute appendicitis, and determining the impact iCECT on the clinical management of the patient population.
Results: A group of 87 patients consisting of 36 males (41.4 %) and 51 females (58.6%) with median age of 32 years (range 12 to 75 years) were imaged with iCECT to evaluate suspected appendicitis. Of the 87 iCECTs performed, 8
false-positive and 2 false-negative readings were identified, resulting in a sensitivity of 93.5%, specificity of 85.7%, PPV of 78.4%, NPV of 96%, and an overall accuracy of 88.5%. With regard to clinical management, 100% (31/31) of patients with appendicitis, and 4% (2/50) of patients without appendicitis underwent appendectomy. Therefore, the overall negative appendectomy rate was 6.1% (2/33).
Conclusions: iCECT is a useful diagnostic imaging modality for patients suspected of having acute appendicitis but with equivocal clinical findings and/or physical exams. iCECT is particularly useful in excluding the diagnosis of
appendicitis in those without disease.
키워드
급성충수염;컴퓨터단층촬영
Acute appendicitis;Computed tomography
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