title: Better visualization of vermiform appendix with tissue harmonic imaging compared to conventional sonography.
abstract: BACKGROUND
  Surgery of appendicitis carries 7-11% negative appendectomy rates. Sonographically visualized normal appendix precludes unnecessary computed tomography (CT) examination and may reduce negative appendectomy rates. Tissue harmonic imaging (THI) has been reported to improve the overall image quality.
  
  
  OBJECTIVE
  We aimed to assess whether THI is more successful than conventional ultrasonography (US) in detecting normal and pathologic appendices.
  
  
  METHODS
  The study was performed on 185 patients who applied for routine US examinations in whom clinical findings of appendicitis were detected in 25. We searched for the appendix; applying both THI and conventional US to each patient, one before and the other after the routine US examinations. Patients were divided into two groups; one was evaluated first with conventional US and the other first with THI. When the appendix was found, localization, diameter and time spent for visualization were recorded. Twelve patients were operated; all of whom had appendicitis pathologically. Two methods were compared for: 1. Success rates in all patients; female, male and child groups separately; 2. Visualization of pathologic and normal appendices; 3. Time for visualization of appendix; 4. Comparison of success rates in the adult and child population. The relationship between the rate of visualization and body mass index was evaluated.
  
  
  RESULTS
  The appendix was visualized better by THI in all patients, and in the female and male groups (P < 0.001). In children, both methods were more successful compared to adults (P < 0.001, compared to male group, P < 0.001, compared to female group), with no difference between the methods (P = 0.22). When only the normal appendices were concerned, there was significant difference between both methods (P < 0.000). Both methods detected pathologic appendices better than normal ones, with a higher ratio for THI (P = 0.022 for the THI group, and χ(2) = 7.22, P = 0.07 for the conventional US group). THI visualized the appendix faster. Both methods were more successful in lean patients (P = 0.004 for THI, P = 0.001 for conventional US imaging).
  
  
  CONCLUSIONS
  THI visualizes appendix better than conventional US. It is a simple and time saving method that may eliminate further diagnostic imaging, and it may decrease negative appendectomy rates and related complications.
authors.affiliation: Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey.
authors.forename: Mikail
authors.initials: M
authors.lastname: Inal
authors.affiliation: Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey.
authors.forename: Birsen
authors.initials: B
authors.lastname: Unal
authors.affiliation: Department of Radiology, Kirikkale University School of Medicine, Kirikkale, Turkey.
authors.forename: Yasemin Karadeniz
authors.initials: YK
authors.lastname: Bilgili
keywords: Appendicitis; Appendix; Diagnosis; Tissue Harmonic Imaging; Ultrasound Imaging