CT diagnosis of Fitz-Hugh and Curtis syndrome: value of the arterial phase scan.
OBJECTIVE
We wanted to evaluate the role of the arterial phase (AP) together with the portal venous phase (PP) scans in the diagnosis of Fitz-Hugh-Curtis syndrome (FHCS) with using computed tomography (CT).


METHODS
Twenty-five patients with FHCS and 25 women presenting with non-specifically diagnosed acute abdominal pain and who underwent biphasic CT examinations were evaluated. The AP scan included the upper abdomen, and the PP scan included the whole abdomen. Two radiologists blindly and retrospectively reviewed the PP scans first and then they reviewed the AP plus PP scans. The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az). Weighted kappa (wk) statistics were used to measure the interobserver agreement for the presence of CT signs of the pelvic inflammatory disease (PID) on the PP images and FHCS as the diagnosis based on the increased perihepatic enhancement on both sets of images.


RESULTS
The individual diagnostic accuracy of FHCS was higher on the biphasic images (Az = 0.905 and 0.942 for reader 1 and 2, respectively) than on the PP images alone (Az = 0.806 and 0.706, respectively). The interobserver agreement for the presence of PID on the PP images was moderate (wk = 0.530). The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).


CONCLUSIONS
Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.
Joo
Seung Ho
SH
Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul 120-752, Korea. kimnex@yumc.yonsei.ac.kr.
Kim
Myeong-Jin
MJ
Lim
Joon Seok
JS
Kim
Joo Hee
JH
Kim
Ki Whang
KW
D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006505:Hepatitis / Q000000981:diagnostic imaging*; D006801:Humans; D007479:Iopamidol; D008875:Middle Aged; D000292:Pelvic Inflammatory Disease / Q000000981:diagnostic imaging*; D012372:ROC Curve; D012189:Retrospective Studies; D013577:Syndrome; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media; D007479:Iopamidol