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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

The box and whisker plot for the mean confidence scores of the eight CT readers for the exclusion of acute appendicitis in true-negative cases (n = 64). The lower score indicates that readers were more confident at excluding acute appendicitis. White, light gray and gray boxes present transverse, coronal, and combined transverse and coronal sections, respectively. Middle lines of boxes show medians, and upper and lower box margins represent upper and lower quartiles, respectively. The ends of the vertical lines represent the 10th and 90th percentiles. Outliers are plotted as crosses.
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Figure 4: The box and whisker plot for the mean confidence scores of the eight CT readers for the exclusion of acute appendicitis in true-negative cases (n = 64). The lower score indicates that readers were more confident at excluding acute appendicitis. White, light gray and gray boxes present transverse, coronal, and combined transverse and coronal sections, respectively. Middle lines of boxes show medians, and upper and lower box margins represent upper and lower quartiles, respectively. The ends of the vertical lines represent the 10th and 90th percentiles. Outliers are plotted as crosses.

Mentions: For the diagnosis of acute appendicitis, the addition of coronal sections did not significantly increase the mean diagnostic confidence score for radiologists or non-radiologists (Fig. 3). For individual CT readers, additional coronal sections enhanced the diagnostic confidence for an emergency physician (reader 7, p = 0.009), however, reduced confidence for a surgeon (reader 6) (p = 0.039). For exclusion of acute appendicitis, additional coronal sections significantly increased mean scores, and therefore confidence declined, in non-radiologists (Figs. 2, 4) (21.5 [median] vs. 27.5, p = 0.013). However, this trend was not observed in the mean scores of radiologists. Both radiologists and non-radiologists were less confident in the diagnosis of and exclusion of acute appendicitis using coronal sections alone compared to using transverse sections (p < 0.05).


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)

The box and whisker plot for the mean confidence scores of the eight CT readers for the exclusion of acute appendicitis in true-negative cases (n = 64). The lower score indicates that readers were more confident at excluding acute appendicitis. White, light gray and gray boxes present transverse, coronal, and combined transverse and coronal sections, respectively. Middle lines of boxes show medians, and upper and lower box margins represent upper and lower quartiles, respectively. The ends of the vertical lines represent the 10th and 90th percentiles. Outliers are plotted as crosses.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: The box and whisker plot for the mean confidence scores of the eight CT readers for the exclusion of acute appendicitis in true-negative cases (n = 64). The lower score indicates that readers were more confident at excluding acute appendicitis. White, light gray and gray boxes present transverse, coronal, and combined transverse and coronal sections, respectively. Middle lines of boxes show medians, and upper and lower box margins represent upper and lower quartiles, respectively. The ends of the vertical lines represent the 10th and 90th percentiles. Outliers are plotted as crosses.
Mentions: For the diagnosis of acute appendicitis, the addition of coronal sections did not significantly increase the mean diagnostic confidence score for radiologists or non-radiologists (Fig. 3). For individual CT readers, additional coronal sections enhanced the diagnostic confidence for an emergency physician (reader 7, p = 0.009), however, reduced confidence for a surgeon (reader 6) (p = 0.039). For exclusion of acute appendicitis, additional coronal sections significantly increased mean scores, and therefore confidence declined, in non-radiologists (Figs. 2, 4) (21.5 [median] vs. 27.5, p = 0.013). However, this trend was not observed in the mean scores of radiologists. Both radiologists and non-radiologists were less confident in the diagnosis of and exclusion of acute appendicitis using coronal sections alone compared to using transverse sections (p < 0.05).

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