Scientific Exhibit Authors: V. Moustakas, E. Karallas, K. Koutsopoulos ; Rodos/GR, 2

Transcription

1 Diagnosis of Acute Appendicitis: the role of Color Doppler Ultrasound as first-line imaging method and evaluation of the higher diagnostic performances of CT against its disadvantages. Poster No.: C-0708 Congress: ECR 2013 Type: Scientific Exhibit Authors: V. Moustakas, E. Karallas, K. Koutsopoulos ; Rodos/GR, Rhodes/GR Keywords: Acute, Surgery, Radiation effects, Diagnostic procedure, Ultrasound-Colour Doppler, Ultrasound, CT, Management, Emergency, Abdomen DOI: /ecr2013/C-0708 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 20

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3 Purpose Acute appendicitis is the most common abdominal surgical emergency. The diagnosis or exclusion of appendicitis may be made clinically, however clinical examination does not appear to be sufficiently reliable to always identify or exclude acute appendicitis. Because of its speed and accuracy, multislice CT has almost completely supplanted the traditional physical exam, currently the vast majority of patients are exposed to substantial radiation when CTs are used as the first-line imaging choice. However, ultrasound can help the radiologist make a definitive diagnosis in most patients, while a CT is the equivalent to 500 chest X-rays with regard to radiation and it is anticipated that one in 4,000 patients getting a CT of the abdomen will die of the cancer that it causes. On the other hand there is little doubt that technique and experience of the examiner plays a key role in the US diagnosis of appendicitis. The purpose of this study is to evaluate the role of Color Doppler Ultrasound in the diagnosis of acute appendicitis and the higher diagnostic performances of CT against its disadvantages. Images for this section: Page 3 of 20

4 Fig. 1: Ultrasound of the Appendix. Page 4 of 20

5 Fig. 2: Surgery Room Page 5 of 20

6 Methods and Materials Color doppler sonography was performed to several patients, referred for suspected appendicitis, using a Phillips HD11 XE Ultrasound System. First, the entire abdomen was examined with a C5-2 Broadband Curved Array Transducer with 5 to 2 MHz extended operating frequency range, 75 Field of view, steerable pulsed wave, color Doppler, High-PRF Doppler and Color Power Angio. The evaluation of the right lower quadrant was performed mainly using an L12-3 Broadband Linear Array Transducer with 12 to 3 MHz extended frequency range, 35 mm effective aperture length, 10 of trapezoidal imaging, steerable pulsed wave, color Doppler and Color Power Angio. Patients found to be positive to acute appendicitis were admitted for the operating room. Patients with a negative or equivocal ultrasound were: discharged with specific return precautions, admitted for 24 hour observation or undergone a CT scan. Images for this section: Page 6 of 20

7 Fig. 3: Philips HD11XE Ultrasound System Page 7 of 20

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9 Fig. 4: C5-2 Broadband Curved Array Transducer Fig. 5: HD11XE Ultrasound System Console Page 9 of 20

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11 Fig. 6: L12-3 Broadband Linear Array Transducer Page 11 of 20

12 Results More than 100 patients have been referred from the emergency department with a working diagnosis of acute appendicitis. A total of 31 patients were found to be positive to acute appendicitis after the ultrasound scan. From the patients with a negative or equivocal ultrasound, 4 were later diagnosed to have acute appendicitis. Ultrasound was accurate enough for detecting appendicitis in most patients, especialy those who had abdominal musculature with less fat content. The opposite was true for CT scans, where intraperitoneal fat actually improved the diagnostic accuracy for appendicitis Images for this section: Fig. 7: Imaging of the Appendix using color doppler. Page 12 of 20

13 Fig. 8: Appendix Page 13 of 20

14 Fig. 13: Appendix Page 14 of 20

15 Conclusion Any patient who presents to the emergency department with abdominal pain and is suspected to have appendicitis, could benefit from sonographic imaging of their appendix. Ultrasound was accurate enough to handle initial screening. All patients with a positive ultrasound could be directed to surgery, avoiding exposure to radiation. Ultrasonography is a good "rule in" test to confirm appendicitis as its specificity rivals that of CT scanning. Unfortunately, its poor sensitivity in comparison to CT does not allow it to be utilized as a good "rule out" test, necessitating additional testing if the ultrasound result is not positive for appendicitis. Images for this section: Fig. 9: Transverse image of the appendix. Page 15 of 20

16 Fig. 10: Longitudinal image of the appendix. Page 16 of 20

17 References American College of Emergency Physicians, Focus On: Ultrasound for Appendicitis, June 1, 2012 Applied Radiology Journals, Volume 31, Number 3, John P. McGahan, MD, March 2002 Emergency Physicians Monthly,W. Richard Bukata, MD, June 23, 2011 Cal J Emerg Med May; 8(2): Personal Information Dr. Vasileios Moustakas Radiology Department Rhodes General Hospital moustakas.v@hotmail.com Images for this section: Page 17 of 20

18 Fig. 11: Rhodes General Hospital Page 18 of 20

19 Fig. 12: Rhodes General Hospital Page 19 of 20

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