대한대장항문학회

<b>Purpose:</b> Appendicitis represents one of the most common surgical disorders. Typically, the diagnosis can be made from well established clinical criteria, with an acceptable negative appendectomy rate from 7∼25%. However, when surgical<br>intervention is performed in the patients suspected of having appendicitis but with equivocal clinical findings, the negative appendectomy rate approaches 50%. Routine contrast-enhanced computed tomography (CECT) has described as an accurate<br>diagnostic<br>imaging modality in patients with suspected appendicitis. We evaluated the role of intravenous CECT (iCECT) in patients suspected of having appendicitis but with equivocal clinical exams.<br><br><b>Methods:</b> Eighty seven consecutive patients who were thought to have appendicitis but with equivocal clinical findings and/or physical exams were imaged by iCECT over 18 months period. Intravenous contrast-enhanced, spiral abdominal and<br>pelvic<br>images were obtained using 7.5 ㎜ cuts. iCECT images were interpreted by a board-certified radiologist. Main outcome measures included iCECT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accurary and<br>negative appendectomy rate in the diagnosis of acute appendicitis, and determining the impact iCECT on the clinical management of the patient population.<br><br><b>Results:</b> A group of 87 patients consisting of 36 males (41.4 %) and 51 females (58.6%) with median age of 32 years (range 12 to 75 years) were imaged with iCECT to evaluate suspected appendicitis. Of the 87 iCECTs performed, 8<br>false-positive<br>and<br>2 false-negative readings were identified, resulting in a sensitivity of 93.5%, specificity of 85.7%, PPV of 78.4%, NPV of 96%, and an overall accuracy of 88.5%. With regard to clinical management, 100% (31/31) of patients with appendicitis, and<br>4%<br>(2/50) of patients without appendicitis underwent appendectomy. Therefore, the overall negative appendectomy rate was 6.1% (2/33).<br><br><b>Conclusions:</b> iCECT is a useful diagnostic imaging modality for patients suspected of having acute appendicitis but with equivocal clinical findings and/or physical exams. iCECT is particularly useful in excluding the diagnosis of<br>appendicitis in<br>those without disease.<br>