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CT diagnosis of Fitz-Hugh and Curtis syndrome: value of the arterial phase scan.

Joo SH, Kim MJ, Lim JS, Kim JH, Kim KW - Korean J Radiol (2007 Jan-Feb)

Bottom Line: The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az).The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul 120-752, Korea. kimnex@yumc.yonsei.ac.kr.

ABSTRACT

Objective: We wanted to evaluate the role of the arterial phase (AP) together with the portal venous phase (PP) scans in the diagnosis of Fitz-Hugh-Curtis syndrome (FHCS) with using computed tomography (CT).

Materials and methods: Twenty-five patients with FHCS and 25 women presenting with non-specifically diagnosed acute abdominal pain and who underwent biphasic CT examinations were evaluated. The AP scan included the upper abdomen, and the PP scan included the whole abdomen. Two radiologists blindly and retrospectively reviewed the PP scans first and then they reviewed the AP plus PP scans. The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az). Weighted kappa (wk) statistics were used to measure the interobserver agreement for the presence of CT signs of the pelvic inflammatory disease (PID) on the PP images and FHCS as the diagnosis based on the increased perihepatic enhancement on both sets of images.

Results: The individual diagnostic accuracy of FHCS was higher on the biphasic images (Az = 0.905 and 0.942 for reader 1 and 2, respectively) than on the PP images alone (Az = 0.806 and 0.706, respectively). The interobserver agreement for the presence of PID on the PP images was moderate (wk = 0.530). The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).

Conclusion: Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

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Related in: MedlinePlus

Axial contrast-enhanced CT scan in a 40-year-old woman with right upper quadrant pain and fever, which is a true positive example of Fitz-Hugh-Curtis syndrome.A. Arterial phase scan reveals conspicuous increased perihepatic enhancement on the right lobe of the liver.B. Portal venous phase scan reveals conspicuous identical enhancement.
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Figure 3: Axial contrast-enhanced CT scan in a 40-year-old woman with right upper quadrant pain and fever, which is a true positive example of Fitz-Hugh-Curtis syndrome.A. Arterial phase scan reveals conspicuous increased perihepatic enhancement on the right lobe of the liver.B. Portal venous phase scan reveals conspicuous identical enhancement.

Mentions: The increased perihepatic enhancement was perceived by the both readers on both image sets in one patient (Fig. 3). One false positive diagnosis was made by the both readers on the AP plus PP image set. This patient presented with diffuse abdominal pain and the patient showed the increased perihepatic enhancement on the AP image with pelvic fat infiltration (Fig. 4). The patient was clinically diagnosed with mild PID because a mild fluid collection was found on the pelvic ultrasonography performed by the gynecologist with the absence of other clinical or laboratory findings indicative of FHCS. Three more false positive results were made by reader 2 on the interpretation of the AP plus PP image set. Clinically, these patients were diagnosed with PID, but they did not complain of RUQ pain, and no other evidence of FHCS was found. Three false negative diagnoses were made by both readers on the interpretation of the AP plus PP image set. Two patients showed diffuse heterogenous enhancement of the entire liver (Fig. 5), which was considered to be intrahepatic pathology rather than perihepatic enhancement caused by FHCS. However, those patients were clinically diagnosed as FHCS and they were given antibiotic treatment. The abnormal liver enhancement disappeared on the follow up CT two weeks later in one patient, and the other patient was not taken for the follow up CT. In another patient, both readers did not consider that increased perihepatic enhancement was present. The patient had a history of RUQ pain one month prior to the CT examination and had undergone antibiotic treatment.


CT diagnosis of Fitz-Hugh and Curtis syndrome: value of the arterial phase scan.

Joo SH, Kim MJ, Lim JS, Kim JH, Kim KW - Korean J Radiol (2007 Jan-Feb)

Axial contrast-enhanced CT scan in a 40-year-old woman with right upper quadrant pain and fever, which is a true positive example of Fitz-Hugh-Curtis syndrome.A. Arterial phase scan reveals conspicuous increased perihepatic enhancement on the right lobe of the liver.B. Portal venous phase scan reveals conspicuous identical enhancement.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2626697&req=5

Figure 3: Axial contrast-enhanced CT scan in a 40-year-old woman with right upper quadrant pain and fever, which is a true positive example of Fitz-Hugh-Curtis syndrome.A. Arterial phase scan reveals conspicuous increased perihepatic enhancement on the right lobe of the liver.B. Portal venous phase scan reveals conspicuous identical enhancement.
Mentions: The increased perihepatic enhancement was perceived by the both readers on both image sets in one patient (Fig. 3). One false positive diagnosis was made by the both readers on the AP plus PP image set. This patient presented with diffuse abdominal pain and the patient showed the increased perihepatic enhancement on the AP image with pelvic fat infiltration (Fig. 4). The patient was clinically diagnosed with mild PID because a mild fluid collection was found on the pelvic ultrasonography performed by the gynecologist with the absence of other clinical or laboratory findings indicative of FHCS. Three more false positive results were made by reader 2 on the interpretation of the AP plus PP image set. Clinically, these patients were diagnosed with PID, but they did not complain of RUQ pain, and no other evidence of FHCS was found. Three false negative diagnoses were made by both readers on the interpretation of the AP plus PP image set. Two patients showed diffuse heterogenous enhancement of the entire liver (Fig. 5), which was considered to be intrahepatic pathology rather than perihepatic enhancement caused by FHCS. However, those patients were clinically diagnosed as FHCS and they were given antibiotic treatment. The abnormal liver enhancement disappeared on the follow up CT two weeks later in one patient, and the other patient was not taken for the follow up CT. In another patient, both readers did not consider that increased perihepatic enhancement was present. The patient had a history of RUQ pain one month prior to the CT examination and had undergone antibiotic treatment.

Bottom Line: The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az).The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul 120-752, Korea. kimnex@yumc.yonsei.ac.kr.

ABSTRACT

Objective: We wanted to evaluate the role of the arterial phase (AP) together with the portal venous phase (PP) scans in the diagnosis of Fitz-Hugh-Curtis syndrome (FHCS) with using computed tomography (CT).

Materials and methods: Twenty-five patients with FHCS and 25 women presenting with non-specifically diagnosed acute abdominal pain and who underwent biphasic CT examinations were evaluated. The AP scan included the upper abdomen, and the PP scan included the whole abdomen. Two radiologists blindly and retrospectively reviewed the PP scans first and then they reviewed the AP plus PP scans. The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az). Weighted kappa (wk) statistics were used to measure the interobserver agreement for the presence of CT signs of the pelvic inflammatory disease (PID) on the PP images and FHCS as the diagnosis based on the increased perihepatic enhancement on both sets of images.

Results: The individual diagnostic accuracy of FHCS was higher on the biphasic images (Az = 0.905 and 0.942 for reader 1 and 2, respectively) than on the PP images alone (Az = 0.806 and 0.706, respectively). The interobserver agreement for the presence of PID on the PP images was moderate (wk = 0.530). The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719).

Conclusion: Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.

Show MeSH
Related in: MedlinePlus