Purpose: To report our experience in using ultrasonography (US) with graded-compression technique in
the evaluation of suspected acute appendicitis (AA).
Patients and Methods: Between January 2003 and September 2004, 500 patients with clinical suspicion
of AA (age range, 7-67 years; mean age, 35.5 years) were included in a prospective study. After clinical
examination and laboratory analysis, the patients were assigned to undergo US examination. The results of
sonographic diagnosis were correlated with surgical and clinical follow-up findings.
Results: According to sonographic diagnosis, the patients were classified into two groups. Group A
included 369 patients with sonographic diagnosis ofAA and group B comprised 131 patients with alternative
diagnosis to AA. The final diagnosis of AA was achieved in 387 (77.4 %) out of the 500 patients with
clinically suspected appendicitis. In group A, 352 (95.4 %) patients proved to have AA (true-positive based
US results) while 17 (4.6 %) had false positive results. On the other hand US excluded the presence of AA
in 96 (73.3 %) out of the 131 patients with altemative diagnosis to AA (true-negative based US results) and
misdiagnosed 35 (26.7 %) patients proved to have AA (false-negative results). So the overall accuracy of
US in the diagnosis of AA was 91 % (352/387). A total of 437 (87.4%) patients were surgically treated. The
perforation rate was 23.2%. US accurately diagnosed perforation in 76.7 % and excluded the presence of
perforation in 95.3 %. An appendicolith was identified with US in 28.4 % of patients with AA [71 % with -
perforated AA 29 % of non-perforated AM. The negative appendectomy rate (NAR) was 4.3% (64.7 %
men and 35.3% women).
Conclusion: US using the graded-compression technique was able to accurately diagnose patients with
suspected acute appendicitis and its complications as well as alternative diagnoses. |
