Ulus Travma Acil Cerrahi Derg. 2017; 23(3): 188-192 | DOI: 10.5505/tjtes.2016.10576

Diagnostic value of appendicular Doppler ultrasonography in acute appendicitis

Hüseyin Uzunosmanoðlu¹, Yunsur Çevik¹, Kerem Þeref Çorbacýoðlu¹, Emine Akýncý¹, Hakan Buluþ², Kadir Aðladýoðlu^3
1Department of Emergency Medicine, Keçiören Training and Research Hospital, Ankara-Turkey
²Department of General Surgery, Keçiören Training and Research Hospital, Ankara-Turkey
³Department of Radiology, Pamukkale University Faculty of Medicine, Denizli-Turkey

BACKGROUND: Acute appendicitis is one of the most common causes of acute abdominal pain prompting emergency department (ED) visits. It is critical for the physicians to promptly and accurately diagnose acute appendicitis. The present study aimed to evaluate the diagnostic efficacy of Doppler ultrasonography (USG) in patients with acute appendicitis and compare this new method with other commonly used radio-diagnostic tools.
METHODS: All patients who were diagnosed with acute appendicitis at the Kecioren Training and Research Hospital ED and later underwent appendectomy between October 2012 and April 2013 were included in the study. Approval from the ethics committee was obtained for this prospective study. The patients’ demographic information, physical examination findings, vital signs, Alvarado scores, and laboratory and radiological exam results were recorded.
RESULTS: A total of 60 patients were enrolled in the study. In 46 of the 60 patients, diagnosis of acute appendicitis was confirmed by histopathology results, whereas 14 patients, diagnoses was not confirmed by lab tests. Doppler USG could detect 43 of the 46 patients as true positives, and it detected 2 of the 14 patients with negative lab results as false positives. For diagnosis of acute appendicitis, sensitivity of appendicular Doppler USG was 93%, specificity was 85%, accuracy was 91%, positive likelihood ratio was 6.5, and negative likelihood ratio was 0.08.
CONCLUSION: Doppler imaging can offer a high level of diagnostic success in patients with acute appendicitis. Appendicular Doppler USG offers a rapid and easy application without the need to expose patients to contrast medium and is superior to both USG and computed tomography. Therefore, we recommend the use of appendicular Doppler imaging as the primary radiological exam in diagnosing acute appendicitis.

Keywords: Acute appendicitis, appendicular Doppler ultrasonography, emergency radiology.

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Akut apandisitte appendiküler Dopplerin tanýsal deðerliliði

Hüseyin Uzunosmanoðlu¹, Yunsur Çevik¹, Kerem Þeref Çorbacýoðlu¹, Emine Akýncý¹, Hakan Buluþ², Kadir Aðladýoðlu^3
1Keçiören Eðitim Ve Araþtýrma Hastanesi, Acil Týp Kliniði, Ankara, Türkiye
²Keçiören Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ankara, Türkiye
³Pamukkale Üniversitesi, Týp Fakültesi, Radyoloji Kliniði, Denizli, Türkiye

AMAÇ: Akut apandisit ani baþlangýçlý karýn aðrýsý nedeni ile acil servis baþvurularýnda en sýk karþýlaþýlan nedenlerden birisidir. Hekimler için akut apandisit tanýsýnýn zamanýnda ve doðru olarak konulmasý kritiktir. Bu çalýþmanýn amacý akut apandisit tanýlý hastalarda Doppler ultrasonografinin (USG)tanýsal deðerliliðini deðerlendirmek ve bu yeni tanýsal metodu diðer sýk kullanýlan tanýsal metotlarla karþýlaþtýrmaktýr.
GEREÇ VE YÖNTEM: Ekim 2012 ile Nisan 2013 arasýnda Keçiören Eðitim ve Araþtýrma Hastanesi’ne baþvuran ve akut apandisit tanýsý alan sonrasýnda ise apendektomiye alýnan hastalar çalýþmaya dahil edildi. Ýleriye yönelik olan çalýþmaya baþlanmadan önce lokal etik kuruldan izin alýndý. Hastalarýn demografik verileri, fizik muayene bulgularý, vital bulgularý, Alvarado skorlarý, radyoloji ve laboratuvar sonuçlarý kayýt edildi.
BULGULAR: Toplamda 60 hasta çalýþmaya dahil edildi. Kýrk altý hasta yapýlan cerrahi sonrasý patolojik olarak apendisit tanýsý doðrulanýrken 14 hasta patolojik sonuçlarla doðrulanmadý. Doppler USG 46 hastanýn 43’ünü doðru pozitif olarak saptayabilirken iki hastayý yanlýþ pozitif olarak yorumladý. Doppler USG duyarlýlýðý 0.93, özgüllüðü 0.85, doðruluk 0.91, pozitif likelihood ratio (PLR) 6.5 ve negatif likelihood ratio 0.08 olarak bulundu.
TARTIÞMA: Doppler USG akut apandisit hastalarýnýn taný sürecinde yüksek seviyede baþarýlý gibi görünmektedir. Hýzlý ve kolay uygulanabilmesi, hastaya kontrast madde verilmemesi nedenleri ile klasik USG ve bilgisayarlý tomografiye üstün gibi görünmektedir. Biz bundan dolayý Doppler USG’nin akut apandisit tanýsýnda öncelikle kullanýlmasý gerektiðini önermekteyiz.

Anahtar Kelimeler: Apendiküler doppler USG, Akut apandisit, acil radyoloji

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