title: Added value of ultrasound re-evaluation for patients with equivocal CT findings of acute appendicitis: a preliminary study.
abstract: OBJECTIVE
  To prospectively estimate the additional diagnostic value of ultrasound (US) re-evaluation for patients with equivocal computed tomography (CT) findings of acute appendicitis.
  
  
  METHODS
  Between April 2011 and October 2011, 869 consecutive patients with suspected appendicitis who were referred for CT were included. The likelihood of appendicitis was prospectively categorized into five categories. US re-evaluation was recommended for patients in the 'equivocal appendix' and 'probably not appendicitis' groups. The overall negative appendectomy rate during the study period was compared with the rate of the previous year, and negative appendectomy rates of the US and non-US evaluation groups were also compared.
  
  
  RESULTS
  Among 869 patients, 71 (8.2 %) had equivocal appendicitis findings and 63 (7.2 %) were diagnosed as probably not appendicitis. The sensitivity and specificity of CT combined with US re-evaluation group (100 % and 98.1 %, respectively) exceeded those of the CT alone group (93 % and 99 %; equivocal group considered as negative appendicitis, 100 % and 89.9 %; as positive, respectively, P < 0.0001). After adding US re-evaluation, the overall negative appendectomy rate in our institution decreased from 3.4 to 2.3 %.
  
  
  CONCLUSIONS
  For patients with equivocal CT findings of acute appendicitis, US re-evaluation can improve diagnostic accuracy and decrease the rate of negative appendectomies.
  
  
  CONCLUSIONS
  • Misdiagnosis of appendicitis still occurs, especially in patients with equivocal radiological findings. • The sensitivity and specificity of CT followed by US exceeded those of CT alone. • After US re-evaluation, the negative appendectomy rate decreased from 3.4 to 2.3 %. • US re-evaluation in equivocal cases helps diagnostic confidence and further management.
authors: Department of Radiology, Daejin Medical Center Bundang Jesaeng General Hospital, 255-2, Seohyun-dong, Bundang-gu, Sungnam-si, Gyeonggi-do 463-774, Republic of Korea.
authors: Ji Ye
authors: JY
authors: Sim
authors: Hyuk Jung
authors: HJ
authors: Kim
authors: Jae Woo
authors: JW
authors: Yeon
authors: Byoung Sun
authors: BS
authors: Suh
authors: Ki Ho
authors: KH
authors: Kim
authors: Young Rock
authors: YR
authors: Ha
authors: So Ya
authors: SY
authors: Paik
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001062:Appendectomy / Q000379:methods; D001064:Appendicitis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D001065:Appendix / Q000000981:diagnostic imaging / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014463:Ultrasonography; D019564:Unnecessary Procedures; D055815:Young Adult
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