Serra ÖZBAL GÜNEŞ, Yeliz AKTÜRK, Kerim Bora YILMAZ

Akut apandisit tanısında kontrastsız bilgisayarlı tomografinin etkinliği

Amaç: Akut apandisit tanısının konulmasında intravenöz kontrast madde kullanılarak ve kullanılmadan elde edilen bilgisayarlı tomografi incelemelerinin etkinliğini karşılaştırmaktır.Gereç ve Yöntem: 1 Ocak 2017 ile 1 Şubat 2018 tarihleri arasında, acil servise akut nontravmatik karın ağrısı ile başvuran, akut apandisitit ön tanısı ile bilgisayarlı tomografi incelemesi yapılan, 18 yaş üstü hastaların medikal kayıtları ve görüntüleme bulguları retrospektif değerlendirildi. Çalışmaya 149 hasta (erkek/kadın=88/61) dahil edildi. Bilgisayarlı tomografi görüntüleri, hastaların daha önceki bilgisayarlı tomografi raporunu ve nihai tanısını bilmeyen bir radyolog tarafından değerlendirildi. Akut apandisit tanısında kontrastsız ve kontrastlı bilgisayarlı tomografinin duyarlılığı, özgüllüğü, pozitif ve negatif tahmini değeri, doğruluğu analiz edildi.Bulgular: Bilgisayarlı tomografide 81/149 hasta (erkek/kadın=48/33, yaşları 18–74 arasında; ortalama yaş 33,6) akut apandisit olarak değerlendirildi. Kontrastsız ve kontrastlı bilgisayarlı tomografi ile akut apandisit tanısı konulan erkekler ile kadınlar arasında, yaş, apendiksin çapı, apendikolit görülmesi bakımından anlamlı farklılık saptanmadı (p>0,05). Cerrahi sonuçlarına ve hastaların klinik takiplere göre kontrastsız ve kontrastlı bilgisayarlı tomografinin akut apandisit tanısı koymada duyarlılığı, özgüllüğü, pozitif ve negatif tahmini değeri, doğruluk oranı sırasıyla: %97,9, %94,6%, %95,9 ve %97,2, %96,5 ; %96,9, %95,8, %96,9 ve %95,8, %96,4 bulundu. Sonuçlar: Akut apandisitin tanısında kontrastsız bilgisayarlı tomografinin, kontrastlı bilgisayarlı tomografi kadar tanısal doğruluğu ve duyarlılığı bulunmaktadır. Hasta yoğunluğunun fazla olduğu acil servislerde kontrast madde kullanılmadan da akut apandisit tanısı koyulabilir.

Anahtar Kelimeler:

Apandisit, bilgisayarlı, tomografi

The efficacy of nonenhanced computed tomography in the diagnosis of acute appendicitis

Aim: To compare the effectiveness of contrast-enhanced (CCT) and nonenhanced computed tomography (NECT) in the diagnosis of acute appendicitis.Material and Method: Patients’ reported to have acute appendicitis on abdominal computed tomography (CT) between January 2017 and February 2018 were identified from the radiology database.The images and clinical characteristics of 149 consecutive identified patients (male/female=88/61) were evaluated. The specific CT findings of acute appendicitis were recorded separately for NECT and CCT images by one radiologists without knowledge of the identity and final diagnosis of the patients. The sensitivity, specificity, positive and negative predictive values, and accuracy of CT diagnosis for acute appendicitis were compared to the clinical and surgical findings. Results: Eighty-one (54.4%) of the 149 patients (males/females=48/33,age range:18–74 years; mean age:33.6 years) were acute appendicitis. There was no significant difference in mean age, appendiceal diameter, and presenting appendicolith between males and females in NECT and CCT groups (p ranged from 0.113 to 1). Sensitivity, specificity, positive and negative predictive values and accuracy for the diagnosis of acute appendicitis were 97.9%, 94.6%, 95.9% and 97.2%, 96.5%, respectively in patients with NECT; 96.9%, 95.8%, 96.9%, and 95.8%, %96.4, respectively in patients with CCT. Conclusion: The diagnostic sensitivity, specificity, and accuracy of NECT are similar to CCT for the diagnosis of acute appendicitis. NECT has several advantages for patients with suspected appendicitis in a busy emergency department setting.

Keywords:

Appendicitis, computed tomography,

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