[Ultrasound diagnosis of acute appendicitis--possibilities and limits of the method--results of prospective and retrospective clinical studies].
OBJECTIVE
In the diagnosis of appendicitis high-resolution ultrasound has become "gold standard" among the imaging methods. The ranking of the method and its dependence on the experience of the examiner, the quality of different ultrasound machines and the time of the examination, were examined in a trial during a 7-year period.


METHODS
In 905 patients examination by the surgeon was followed by ultrasound. The results were compared with clinical or histological diagnosis.


RESULTS
In a prospective study we examined sonographical 367 patients with the diagnosis of "appendicitis" at admission. The sensitivity was 75.3%, the specificity 96.2%. In a retrospective analysis of 538 patients with appendectomy, the sensitivity was 50.5% and the specificity 95.4% in pre-operative diagnosis. If the examination was done by a less experienced examiner (less than 500 ultrasound examinations/year) the sensitivity was 45.1% and specificity 93.6%; an experienced doctor (500-1000 ultrasound examinations/year) achieved 57.9 and 92.9% and a highly qualified investigator (more than 1000 ultrasound examinations/year) a sensitivity of 73.9% and a specificity of 97%. If the examination was realised with high frequency ultrasonic scanning (10 MHz), sensitivity (73.9%) and specificity (96.3%) could be increased. Essential for an exact diagnosis was a short-term period between ultrasound examination and intra-abdominal diagnosis.


CONCLUSIONS
Optimal sonographical appendicitis diagnosis must be based on a combination of a qualified examiner, high-resolution ultrasound and short-term follow-up.
Uebel
P
P
Med. Klinik St. Marienkrankenhaus, Ludwigshafen.
Weiss
H
H
Trimborn
C P
CP
Fiedler
L
L
Bersch
W
W
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography
Die sonographische Diagnostik der akuten Appendizitis--Möglichkeiten und Grenzen einer Methode--Ergebnisse prospektiver und retrospektiver klinischer Studien.