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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 of a 32-year-old man with epigastric pain and fever. Transverse CT scan (A) and coronal reformation (B) obtained with intravenous contrast material show distended appendix (arrows), an appendicolith (arrowheads), and periappendiceal fat stranding. Coronal reformation shows the entire length of the horseshoe-shaped appendix within a coronal plane. At surgery, an inflamed appendix was identified and removed. All readers correctly diagnosed acute appendicitis in both transverse sections alone and combined transverse and coronal sections. The mean appendiceal visualization score was 87.1 and 94.3 for radiologists, and 86.1 and 88.3 for non-radiologists.
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Figure 5: CT scans of a 32-year-old man with epigastric pain and fever. Transverse CT scan (A) and coronal reformation (B) obtained with intravenous contrast material show distended appendix (arrows), an appendicolith (arrowheads), and periappendiceal fat stranding. Coronal reformation shows the entire length of the horseshoe-shaped appendix within a coronal plane. At surgery, an inflamed appendix was identified and removed. All readers correctly diagnosed acute appendicitis in both transverse sections alone and combined transverse and coronal sections. The mean appendiceal visualization score was 87.1 and 94.3 for radiologists, and 86.1 and 88.3 for non-radiologists.

Mentions: The mean score for a radiologist to visualize the appendix significantly increased by adding coronal sections in true-positive cases (p = 0.031) (Figs. 5, 6). However, this trend was not observed for the non-radiologists. In true-negative cases, no significant difference in the mean appendiceal visualization score was observed in any of the CT reader groups (Fig. 7). Mean score for coronal sections alone in all 110 cases was lower than that for transverse sections in both CT reader groups (p < 0.03).


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 of a 32-year-old man with epigastric pain and fever. Transverse CT scan (A) and coronal reformation (B) obtained with intravenous contrast material show distended appendix (arrows), an appendicolith (arrowheads), and periappendiceal fat stranding. Coronal reformation shows the entire length of the horseshoe-shaped appendix within a coronal plane. At surgery, an inflamed appendix was identified and removed. All readers correctly diagnosed acute appendicitis in both transverse sections alone and combined transverse and coronal sections. The mean appendiceal visualization score was 87.1 and 94.3 for radiologists, and 86.1 and 88.3 for non-radiologists.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: CT scans of a 32-year-old man with epigastric pain and fever. Transverse CT scan (A) and coronal reformation (B) obtained with intravenous contrast material show distended appendix (arrows), an appendicolith (arrowheads), and periappendiceal fat stranding. Coronal reformation shows the entire length of the horseshoe-shaped appendix within a coronal plane. At surgery, an inflamed appendix was identified and removed. All readers correctly diagnosed acute appendicitis in both transverse sections alone and combined transverse and coronal sections. The mean appendiceal visualization score was 87.1 and 94.3 for radiologists, and 86.1 and 88.3 for non-radiologists.
Mentions: The mean score for a radiologist to visualize the appendix significantly increased by adding coronal sections in true-positive cases (p = 0.031) (Figs. 5, 6). However, this trend was not observed for the non-radiologists. In true-negative cases, no significant difference in the mean appendiceal visualization score was observed in any of the CT reader groups (Fig. 7). Mean score for coronal sections alone in all 110 cases was lower than that for transverse sections in both CT reader groups (p < 0.03).

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