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Added value of coronal reformations for duty radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis.

Lee KH, Kim YH, Hahn S, Lee KW, Lee HJ, Kim TJ, Kang SB, Shin JH, Park BJ - Korean J Radiol (2006 Apr-Jun)

Bottom Line: The area under the receiver operating characteristic curve (Az value), sensitivity, specificity (McNemar test), diagnostic confidence and appendiceal visualization (Wilcoxon signed rank test) were compared.For radiologists, the additional coronal sections tended to increase the Az value (0.972 vs. 0.986, p = 0.076) and pooled sensitivity (92% [95% CI:88, 96] vs. 96% [93, 99]), and enhanced appendiceal visualization in true-positive cases (p = 0.031).Coronal sections alone were inferior to transverse sections for diagnostic confidence as well as appendiceal visualization for each reader group studied (p < 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea.

ABSTRACT

Objective: To assess the added value of coronal reformation for radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis.

Materials and methods: Contrast-enhanced CT was performed using 16-detector-row scanners in 110 patients, 46 of whom had appendicitis. Transverse (5-mm thickness, 4-mm increment), coronal (5-mm thickness, 4-mm increment), and combined transverse and coronal sections were interpreted by four radiologists, two surgeons and two emergency physicians. The area under the receiver operating characteristic curve (Az value), sensitivity, specificity (McNemar test), diagnostic confidence and appendiceal visualization (Wilcoxon signed rank test) were compared.

Results: For radiologists, the additional coronal sections tended to increase the Az value (0.972 vs. 0.986, p = 0.076) and pooled sensitivity (92% [95% CI:88, 96] vs. 96% [93, 99]), and enhanced appendiceal visualization in true-positive cases (p = 0.031). For non-radiologists, no such enhancement was observed, and the confidence for excluding acute appendicitis declined (p = 0.013). Coronal sections alone were inferior to transverse sections for diagnostic confidence as well as appendiceal visualization for each reader group studied (p < 0.05).

Conclusion: The added value of coronal reformation is more apparent for radiologists compared to referring physicians or surgeons in the CT diagnosis of acute appendicitis.

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Related in: MedlinePlus

CT scans in a 17-year-old woman with pain and tenderness in the right lower quadrant of abdomen and fever. Transverse CT scans (A, B) and coronal reformation (C) obtained with intravenous contrast material show the appendix (arrows) with the distal portion distended with air. Coronal reformation shows the entire length of the appendix within the coronal plane. Note the mass at the cecal wall (arrowheads) with increased attenuation of surrounding fat. At surgery, an inflamed diverticulum was identified at the cecum and the appendix was considered grossly normal. With transverse sections alone, two readers (readers 3 and 7) incorrectly diagnosed acute appendicitis. With combined transverse and coronal sections, reader 3 altered his decision to correctly exclude acute appendicitis, whereas two non-radiologists (readers 7 and 8) incorrectly diagnosed acute appendicitis. The radiologists rated possibility of diagnosis of appendicitis 32.5 (mean) and 9.7 with transverse sections alone and combined transverse and coronal sections, respectively, whereas the non-radiologists rating was 40.3 and 58.5.
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Figure 2: CT scans in a 17-year-old woman with pain and tenderness in the right lower quadrant of abdomen and fever. Transverse CT scans (A, B) and coronal reformation (C) obtained with intravenous contrast material show the appendix (arrows) with the distal portion distended with air. Coronal reformation shows the entire length of the appendix within the coronal plane. Note the mass at the cecal wall (arrowheads) with increased attenuation of surrounding fat. At surgery, an inflamed diverticulum was identified at the cecum and the appendix was considered grossly normal. With transverse sections alone, two readers (readers 3 and 7) incorrectly diagnosed acute appendicitis. With combined transverse and coronal sections, reader 3 altered his decision to correctly exclude acute appendicitis, whereas two non-radiologists (readers 7 and 8) incorrectly diagnosed acute appendicitis. The radiologists rated possibility of diagnosis of appendicitis 32.5 (mean) and 9.7 with transverse sections alone and combined transverse and coronal sections, respectively, whereas the non-radiologists rating was 40.3 and 58.5.

Mentions: On the basis of a decision threshold of a 50% possibility of acute appendicitis, the alterations of each decision, by the CT readers, (i.e. diagnosis vs. exclusion of acute appendicitis) with the additional coronal sections, from a decision with transverse sections alone, were tabulated and are presented in Table 2. The data averaged among the readers showed that each radiologist altered the decision to correctly diagnose or exclude acute appendicitis in 3.0 (2.7% of 110 patients) patients, and incorrectly to diagnose or exclude in 1.6 (1.5%) patients, whereas each non-radiologist altered the decision correctly in 9.3 (8.5%) and incorrectly in 7.5 (6.8%) patients (Figs. 1, 2).


Added value of coronal reformations for duty radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis.

Lee KH, Kim YH, Hahn S, Lee KW, Lee HJ, Kim TJ, Kang SB, Shin JH, Park BJ - Korean J Radiol (2006 Apr-Jun)

CT scans in a 17-year-old woman with pain and tenderness in the right lower quadrant of abdomen and fever. Transverse CT scans (A, B) and coronal reformation (C) obtained with intravenous contrast material show the appendix (arrows) with the distal portion distended with air. Coronal reformation shows the entire length of the appendix within the coronal plane. Note the mass at the cecal wall (arrowheads) with increased attenuation of surrounding fat. At surgery, an inflamed diverticulum was identified at the cecum and the appendix was considered grossly normal. With transverse sections alone, two readers (readers 3 and 7) incorrectly diagnosed acute appendicitis. With combined transverse and coronal sections, reader 3 altered his decision to correctly exclude acute appendicitis, whereas two non-radiologists (readers 7 and 8) incorrectly diagnosed acute appendicitis. The radiologists rated possibility of diagnosis of appendicitis 32.5 (mean) and 9.7 with transverse sections alone and combined transverse and coronal sections, respectively, whereas the non-radiologists rating was 40.3 and 58.5.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667593&req=5

Figure 2: CT scans in a 17-year-old woman with pain and tenderness in the right lower quadrant of abdomen and fever. Transverse CT scans (A, B) and coronal reformation (C) obtained with intravenous contrast material show the appendix (arrows) with the distal portion distended with air. Coronal reformation shows the entire length of the appendix within the coronal plane. Note the mass at the cecal wall (arrowheads) with increased attenuation of surrounding fat. At surgery, an inflamed diverticulum was identified at the cecum and the appendix was considered grossly normal. With transverse sections alone, two readers (readers 3 and 7) incorrectly diagnosed acute appendicitis. With combined transverse and coronal sections, reader 3 altered his decision to correctly exclude acute appendicitis, whereas two non-radiologists (readers 7 and 8) incorrectly diagnosed acute appendicitis. The radiologists rated possibility of diagnosis of appendicitis 32.5 (mean) and 9.7 with transverse sections alone and combined transverse and coronal sections, respectively, whereas the non-radiologists rating was 40.3 and 58.5.
Mentions: On the basis of a decision threshold of a 50% possibility of acute appendicitis, the alterations of each decision, by the CT readers, (i.e. diagnosis vs. exclusion of acute appendicitis) with the additional coronal sections, from a decision with transverse sections alone, were tabulated and are presented in Table 2. The data averaged among the readers showed that each radiologist altered the decision to correctly diagnose or exclude acute appendicitis in 3.0 (2.7% of 110 patients) patients, and incorrectly to diagnose or exclude in 1.6 (1.5%) patients, whereas each non-radiologist altered the decision correctly in 9.3 (8.5%) and incorrectly in 7.5 (6.8%) patients (Figs. 1, 2).

Bottom Line: The area under the receiver operating characteristic curve (Az value), sensitivity, specificity (McNemar test), diagnostic confidence and appendiceal visualization (Wilcoxon signed rank test) were compared.For radiologists, the additional coronal sections tended to increase the Az value (0.972 vs. 0.986, p = 0.076) and pooled sensitivity (92% [95% CI:88, 96] vs. 96% [93, 99]), and enhanced appendiceal visualization in true-positive cases (p = 0.031).Coronal sections alone were inferior to transverse sections for diagnostic confidence as well as appendiceal visualization for each reader group studied (p < 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi-do, Korea.

ABSTRACT

Objective: To assess the added value of coronal reformation for radiologists and for referring physicians or surgeons in the CT diagnosis of acute appendicitis.

Materials and methods: Contrast-enhanced CT was performed using 16-detector-row scanners in 110 patients, 46 of whom had appendicitis. Transverse (5-mm thickness, 4-mm increment), coronal (5-mm thickness, 4-mm increment), and combined transverse and coronal sections were interpreted by four radiologists, two surgeons and two emergency physicians. The area under the receiver operating characteristic curve (Az value), sensitivity, specificity (McNemar test), diagnostic confidence and appendiceal visualization (Wilcoxon signed rank test) were compared.

Results: For radiologists, the additional coronal sections tended to increase the Az value (0.972 vs. 0.986, p = 0.076) and pooled sensitivity (92% [95% CI:88, 96] vs. 96% [93, 99]), and enhanced appendiceal visualization in true-positive cases (p = 0.031). For non-radiologists, no such enhancement was observed, and the confidence for excluding acute appendicitis declined (p = 0.013). Coronal sections alone were inferior to transverse sections for diagnostic confidence as well as appendiceal visualization for each reader group studied (p < 0.05).

Conclusion: The added value of coronal reformation is more apparent for radiologists compared to referring physicians or surgeons in the CT diagnosis of acute appendicitis.

Show MeSH
Related in: MedlinePlus