DIAGNOSTIC ACCURACY OF GRAY SCALE ULTRASONOGRAPHY VERSUS COLOR DOPPLER IN SUSPECTED CASES OF ACUTE APPENDICITIS
ACUTE APPENDICITIS, GRAY SCALE ULTRASONOGRAPHY, COLOR DOPPLER
DOI:
https://doi.org/10.37978/tijfs.v5i1.319Keywords:
Acute Appendicitis, Gray Scale Ultrasonography, Color DopplerAbstract
ABSTRACT:
BACKGROUND: A common surgical emergency is acute appendicitis. Various diagnostic tools are available to diagnosis acute appendicitis. Radiological investigations play an important role in making accurate and early diagnosis and thus preventing morbidity associated with the disease.
OBJECTIVE: To determine the diagnostic accuracy of gray scale ultrasonography versus color Doppler in suspected cases of acute appendicitis.
MATERIALS AND METHODS: The study was carried in the department of Radiology of Mayo Hospital, Lahore. A total of 75 patients were enrolled of age 18-40 years, both genders who were suspected cases of acute appendicitis. All patients underwent baseline investigations along with gray scale ultrasonography and color Doppler. All patients were subjected to surgery to confirm the diagnosis and findings were subjected to statistical analysis.
RESULTS: The mean age of the patients was 23.25 ±10.55 and mean transverse diameter of appendix was 8.37 ±3.39. There were 62.7% males and 37.3%females. Findings of gray scale ultrasonography and color Doppler were then correlated with surgical findings to calculate the diagnostic accuracy of these modalities. The results revealed that gray scale ultrasonography sensitivity, specificity, positive predictive value, negative predictive value and accuracy was 92.7%, 94.32%, 95%, 91.4% and 93.3% respectively, whereas color Doppler had sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 97.7%, 93.9%, 95.3%, 97% and 96% respectively. Diagnostic accuracy of both modalities together was 98.6%.
CONCLUSION: Color Doppler has better diagnostic accuracy than gray scale ultrasonography for diagnosis of acute appendicitis and the combination of both modalities yields diagnostic accuracy that is similar to gold standard.
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Svensson, J.F., Patkova, B., Almström, M., Naji, H., Hall, N.J., Eaton, S., Pierro, A. and Wester, T., 2015. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Annals of surgery, 261(1), pp.67-71.doi: 10.1097/SLA.0000000000000835
Lee, M., Paavana, T., Mazari, F. and Wilson, T.R., 2014. The morbidity of negative appendicectomy. The Annals of The Royal College of Surgeons of England, 96(7), pp.517-520. doi: 10.1308/003588414X13946184903801
Flum, D.R., 2015. Acute appendicitis—appendectomy or the “antibiotics first” strategy. New England Journal of Medicine, 372(20), pp.1937-1943.doi: 10.1056/NEJMcp1215006
Burcu, B., Ekinci, O., Atak, T., Orhun, K., Eren, T.T. and Alimoglu, O., 2016. Acute appendicitis in pregnancy: Case series and review. Northern clinics of Istanbul, 3(1), p.60.DOI: 10.14744/nci.2015.96530
Subramanyam, V.V., Veersalingam, B., Sateesh, S., Bangla, G. and Rao, P.S., 2013. Role of Alvarado score in the diagnosis of acute appendicitis. International Journal of Research in Medical Sciences, 1(4), pp.404-408.DOI: 10.5455/2320-6012.ijrms20131117
Boonstra, P.A., van Veen, R.N. and Stockmann, H.B.A.C., 2015. Less negative appendectomies due to imaging in patients with suspected appendicitis. Surgical endoscopy, 29(8), pp.2365-2370.DOI: 10.1007/s00464-014-3963-2
Kotaluoto, S., Ukkonen, M., Pauniaho, S.L., Helminen, M., Sand, J. and Rantanen, T., 2017. Mortality Related to Appendectomy; a Population Based Analysis over Two Decades in Finland. World journal of surgery, 41(1), pp.64-69.doi: 10.1007/s00268-016-3688-6
Lahaye, M.J., Lambregts, D.M.J., Mutsaers, E., Essers, B.A.B., Breukink, S., Cappendijk, V.C., Beets, G.L. and Beets-Tan, R.G.H., 2015. Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis. European radiology, 25(5), pp.1464-1470.https://doi.org/10.1007/s00330-014-3531-0
Samir, M., Hefzy, M., Gaber, M. and Moghazy, K., 2016. Added value of graded compression ultrasound to the Alvarado score in cases of right iliac fossa pain. African Journal of Emergency Medicine, 6(3), pp.138-143.DOI: 10.1016/j.afjem.2016.02.004
Kim, S.H., Choi, Y.H., Kim, W.S., Cheon, J.E. and Kim, I.O., 2014. Acute appendicitis in children: ultrasound and CT findings in negative appendectomy cases. Pediatric radiology, 44(10), pp.1243-1251.http://dx.doi.org/10.1007/s00247-014-3009-x
Mostbeck, G., Adam, E.J., Nielsen, M.B., Claudon, M., Clevert, D., Nicolau, C., Nyhsen, C. and Owens, C.M., 2016. How to diagnose acute appendicitis: ultrasound first. Insights into imaging, 7(2), pp.255-263.doi: 10.1007/s13244-016-0469-6
Joseph, H.T., Sharma, M.B., Das, S., Pertin, M., Hatzaw, Z., Jesu, P.R. and Singh, S., The Diagnostic Role of Colour Doppler in Acute Appendicitis.DOI: 10.9790/0853-1902102734
D'Souza, N., D'Souza, C., Grant, D., Royston, E. and Farouk, M., 2015. The value of ultrasonography in the diagnosis of appendicitis. International journal of surgery, 13, pp.165-169.https://doi.org/10.1016/j.ijsu.2014.11.039
Shrestha, M.S., Pant, H.P., Basnet, S.B., Khadka, G.B., Shahi, R.R. and Panta, S., 2015. Role of Graded Compression Ultrasonography in Evaluation of Acute Appendicitis. Medical Journal of Shree Birendra Hospital, 12(2), pp.49-53.DOI: https://doi.org/10.3126/mjsbh.v12i2.12929
Shirah, B.H., Shirah, H.A., Alhaidari, W.A., Elraghi, M.A. and Chughtai, M.A., 2017. The role of preoperative graded compression ultrasound in detecting acute appendicitis and influencing the negative appendectomy rate. Abdominal Radiology, 42(1), pp.109-114.doi: 10.1007/s00261-016-0862-0
Al-Marzooq, T.J., Hassan, Q.A., Majeed, G.H., Manea, A.N. and Abboud, A.H., 2017. The Diagnostic Accuracy of Sonography, With Graded Compression to Image Acute Appendicitis Compared to Histopathologic Results. Journal of Diagnostic Medical Sonography, p.8756479317712196.https://doi.org/10.1177/8756479317712196
Sim, K.T., Picone, S., Crade, M. and Sweeney, J.P., 1989. Ultrasound with graded compression in the evaluation of acute appendicitis. Journal of the National Medical Association, 81(9), p.954.PMID: 2674464
Fathi, M., Hasani, S.A., Zare, M.A., Daadpey, M., Firoozabadi, N.H. and Lotfi, D., 2015. Diagnostic accuracy of emergency physician performed graded compression ultrasound study in acute appendicitis: a prospective study. Journal of ultrasound, 18(1), pp.57-62.doi: 10.1007/s40477-014-0130-5
Lee, J.H., Jeong, Y.K., Park, K.B., Park, J.K., Jeong, A.K. and Hwang, J.C., 2005. Operator-dependent techniques for graded compression sonography to detect the appendix and diagnose acute appendicitis. American Journal of Roentgenology, 184(1), pp.91-97.DOI: 10.2214/ajr.184.1.01840091
Worrell, J.A., Drolshagen, L.F., Kelly, T.C., Hunton, D.W., Durmon, G.R. and Fleischer, A.C., 1990. Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria. Journal of ultrasound in medicine, 9(3), pp.145-150.https://doi.org/10.7863/jum.1990.9.3.145
Puylaert, J.B., 1986. Acute appendicitis: US evaluation using graded compression. Radiology, 158(2), pp.355-360.doi: 10.1148/radiology.158.2.2934762
Bhangu, A., Søreide, K., Di Saverio, S., Assarsson, J.H. and Drake, F.T., 2015. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet, 386(10000), pp.1278-1287.doi: 10.1016/S0140-6736(15)00275-5.
Elahifar, M.A., Taheri, H. and Bighamian, A., 2012. Diagnostic Value of Ultrasonography in Patients Suspected Acute Appendicitis. Nepalese Journal of Radiology, 2(2), pp.13-19. DOI: https://doi.org/10.3126/njr.v2i2.7680
Torres, O.J.M., Lins, A.D.A.L., Nunes, P.M.S., Corrêa, F.C.F., Carvalho Júnior, O.S.D. and Castro, F.C., 2001. Ultrasonographic evaluation of acute appendicitis. Revista do Colégio Brasileiro de Cirurgiões, 28(1), pp.39-43. https://doi.org/10.1590/S0100-69912001000100008
Gaitini, D., Beck-Razi, N., Mor-Yosef, D., Fischer, D., Itzhak, O.B., Krausz, M.M. and Engel, A., 2008. Diagnosing acute appendicitis in adults: accuracy of color Doppler sonography and MDCT compared with surgery and clinical follow-up. American Journal of Roentgenology, 190(5), pp.1300-1306.DOI:10.2214/AJR.07.2955
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