Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Useful Ultrasound Findings of Pediatric Patients with Equivocal Results of Appendicitis: Analysis Based on a Structured Report Form

애매한 초음파 결과를 보인 소아 환자에서 충수돌기염을 감별하는데 유용한 초음파 소견: 구조화 판독문에 기초한 분석

  • Jiyoung Choi (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Hyuk Jung Kim (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Suk Ki Jang (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Hyun Jin Kim (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital) ;
  • Jae Woo Yeon (Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital)
  • Received : 2019.12.11
  • Accepted : 2020.05.07
  • Published : 2021.01.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose To identify the features that can be used for differentiating appendicitis from non-appendicitis in pediatric patients with equivocal ultrasound (US) results. Materials and Methods A total of 53 pediatric patients (≤ 18 years old) with equivocal results on US examination for suspected appendicitis between November 2012 and October 2017 were included. US evaluation was conducted based on information retrieved from a predefined structured report form. Then, the likelihood of appendicitis was prospectively classified into five categories. The equivocal results were considered as grade 3 (indeterminate) and grade 4 (probably appendicitis). Results Of the 53 patients, 25 (47.2%) and 28 (52.8%) were classified into grade 3 and 4 groups, respectively. Among the individual US findings, increased vascularity of the appendiceal wall and peri-appendiceal fat infiltration were independent findings associated with the diagnosis of appendicitis (p = 0.005, p = 0.045, respectively) in the multivariate logistic regression analysis and showed the highest diagnostic accuracy (69.8% and 62.3%, respectively). Conclusion Increased vascularity within the appendiceal wall and peri-appendiceal fat infiltration were significant predictors of appendicitis in patients with equivocal US findings.

목적 애매한 초음파 결과를 보인 소아 환자들에서 충수돌기염을 감별하는 데 도움이 되는 초음파 소견들을 알아보고자 한다. 대상과 방법 2012년 11월부터 2017년 10월 사이에 충수돌기염이 의심되어 초음파를 시행한 소아 환자 중 애매한 결과를 보인 53명의 환자를 대상으로 하였다. 초음파 검사는 정해진 구조화 판독문을 사용했으며 충수돌기염의 가능성은 5가지로 분류되었다. 그중 3등급과 4등급을 애매한 결과로 간주하였다. 결과 53명의 환자 중 각각 25명(47.2%)과 28명(52.8%)이 3등급과 4등급으로 분류되었다. 각 초음파 소견 중 충수돌기 벽의 혈류 증가와 충수돌기 주변의 지방 침윤이 충수돌기염을 진단하는 데 다변량 로지스틱 회귀분석에서 의미 있는 소견이었고(p = 0.005, p = 0.045), 진단적 정확도도 높았다(69.8%, 62.3%). 결론 충수돌기 벽의 혈류 증가와 충수돌기 주변의 지방 침윤은 애매한 초음파 결과를 보인 소아 환자들에서 의미 있는 충수돌기염의 예견 인자이다.

Keywords

Acknowledgement

This research was supported by grants from the Central Medical Service. Co., Ltd. (DMC 2018-11-007-001).

References

  1. Puylaert JB, Van der Zant FM, Rijke AM. Sonography and the acute abdomen: practical considerations. AJR Am J Roentgenol 1997;168:179-186  https://doi.org/10.2214/ajr.168.1.8976943
  2. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 2006;241:83-94  https://doi.org/10.1148/radiol.2411050913
  3. Mittal MK, Dayan PS, Macias CG, Bachur RG, Bennett J, Dudley NC, et al. Performance of ultrasound in the diagnosis of appendicitis in children in a multicenter cohort. Acad Emerg Med 2013;20:697-702  https://doi.org/10.1111/acem.12161
  4. Larson DB, Trout AT, Fierke SR, Towbin AJ. Improvement in diagnostic accuracy of ultrasound of the pediatric appendix through the use of equivocal interpretive categories. AJR Am J Roentgenol 2015;204:849-856  https://doi.org/10.2214/AJR.14.13026
  5. Kim MS, Kwon HJ, Kang KA, Do IG, Park HJ, Kim EY, et al. Diagnostic performance and useful findings of ultrasound re-evaluation for patients with equivocal CT features of acute appendicitis. Br J Radiol 2018;91:20170529 
  6. Athans BS, Depinet HE, Towbin AJ, Zhang Y, Zhang B, Trout AT. Use of clinical data to predict appendicitis in patients with equivocal US findings. Radiology 2016;280:557-567  https://doi.org/10.1148/radiol.2016151412
  7. Ang A, Chong NK, Daneman A. Pediatric appendicitis in "real-time": the value of sonography in diagnosis and treatment. Pediatr Emerg Care 2001;17:334-340  https://doi.org/10.1097/00006565-200110000-00004
  8. Telesmanich ME, Orth RC, Zhang W, Lopez ME, Carpenter JL, Mahmood N, et al. Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams. Pediatr Radiol 2016;46:1539-1545  https://doi.org/10.1007/s00247-016-3645-4
  9. Kaiser S, Jorulf H, Soderman E, Frenckner B. Impact of radiologic imaging on the surgical decision-making process in suspected appendicitis in children. Acad Radiol 2004;11:971-979  https://doi.org/10.1016/j.acra.2004.05.023
  10. Trout AT, Sanchez R, Ladino-Torres MF, Pai DR, Strouse PJ. A critical evaluation of US for the diagnosis of pediatric acute appendicitis in a real-life setting: how can we improve the diagnostic value of sonography? Pediatr Radiol 2012;42:813-823  https://doi.org/10.1007/s00247-012-2358-6
  11. Fallon SC, Orth RC, Guillerman RP, Munden MM, Zhang W, Elder SC, et al. Development and validation of an ultrasound scoring system for children with suspected acute appendicitis. Pediatr Radiol 2015;45:1945-1952  https://doi.org/10.1007/s00247-015-3443-4
  12. Trout AT, Sanchez R, Ladino-Torres MF. Reevaluating the sonographic criteria for acute appendicitis in children: a review of the literature and a retrospective analysis of 246 cases. Acad Radiol 2012;19:1382-1394  https://doi.org/10.1016/j.acra.2012.06.014
  13. Jeffrey RB Jr, Laing FC, Townsend RR. Acute appendicitis: sonographic criteria based on 250 cases. Radiology 1988;167:327-329  https://doi.org/10.1148/radiology.167.2.3282253
  14. Worrell JA, Drolshagen LF, Kelly TC, Hunton DW, Durmon GR, Fleischer AC. Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria. J Ultrasound Med 1990;9:145-150  https://doi.org/10.7863/jum.1990.9.3.145
  15. Abu-Yousef MM, Bleicher JJ, Maher JW, Urdaneta LF, Franken EA Jr, Metcalf AM. High-resolution sonography of acute appendicitis. AJR Am J Roentgenol 1987;149:53-58  https://doi.org/10.2214/ajr.149.1.53
  16. Lim HK, Lee WJ, Kim TH, Namgung S, Lee SJ, Lim JH. Appendicitis: usefulness of color Doppler US. Radiology 1996;201:221-225  https://doi.org/10.1148/radiology.201.1.8816547
  17. Xu Y, Jeffrey RB, Shin LK, DiMaio MA, Olcott EW. Color Doppler imaging of the appendix: criteria to improve specificity for appendicitis in the borderline-size appendix. J Ultrasound Med 2016;35:2129-2138  https://doi.org/10.7863/ultra.15.11064
  18. Kwon LM, Lee K, Min SK, Ahn SM, Ha HI, Kim MJ. Ultrasound features of secondary appendicitis in pediatric patients. Ultrasonography 2018;37:233-243  https://doi.org/10.14366/usg.17029
  19. Bhangu A, Soreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet 2015;386:1278-1287  https://doi.org/10.1016/S0140-6736(15)00275-5
  20. Patriquin HB, Garcier JM, Lafortune M, Yazbeck S, Russo P, Jequier S, et al. Appendicitis in children and young adults: Doppler sonographic-pathologic correlation. AJR Am J Roentgenol 1996;166:629-633 https://doi.org/10.2214/ajr.166.3.8623640