Akut appendisitin ÇKBT tanısında appendiks bükülme açısı ek bir tanısal bulgu olabilir mi?

Year 2020, Volume: 4 Issue: 1, 76 - 81, 02.03.2020

Nurcan Ertan Tuba Akdağ , İrmak Durur Subaşı İsmail Oskay Kaya , Baki Hekimoglu

https://doi.org/10.30565/medalanya.622116

Cited By: 1

Abstract

Amaç: Bilgisayarlı tomografi (BT), akut apandisit tanısında sık kullanılan bir görüntüleme yöntemidir. Akut apandisiti saptamak için BT'de en sık kullanılan ölçüm; apendiks en geniş dış çapının transvers düzlemde ölçümüdür. Birçok çalışma apendiks duvar kalınlığı, apendiks duvar kontrastlanması, peri-apendiküler serbest sıvısı, peri-apendiküler enflamasyon, peri-apendiküler lenf nodu, apendikolit ve çekum duvar kalınlaşması gibi akut apandisitin diğer BT bulgularını bildirilmiştir. Biz çalışmamızda akut apandisit tanısında apendiks bükülme açısının (ABA) tanıya ek ve yeni bir bulgu olarak katkısını araştırdık.
Yöntemler: Bu retrospektif çalışma enstitüden etik kurul onayı alındıktan sonra yapıldı. Çalışma grubuna ardışık tarihlerde apendektomi yapılan 52 hasta alındı. Akut batın dışı nedenlerle abdominal BT çekilen hastalardan da kontrol grubu oluşturuldu.
Bulgular: Akut apandisit grubunun yaş ortalaması 41.9 ± 16.0 idi. Erkek hastalar çoğunluktaydı (n = 32, %61.5). Akut apandisit grubunda peri-apendiküler inflamasyon %65.4, peri-apendiküler lenf nodu %73.1 ve apendikolit %9.6 oranlarında pozitif bulundu. Ortalama ABA, çalışma grubunda 103.0 ± 15.9 derece, kontrol grubunda ise 118.8 ± 23.8 derece idi (p <0.001). ABA'nın duyarlılığı % 76.9 olarak hesaplandı ve özgüllüğü ROC eğrisi ile hesaplanan en iyi kesme noktası olan 113.15 derecede % 58.3 idi. 142.3 derecenin üzerinde akut apandisit saptanmadı.
Sonuç: ABA’nın azalmış olması akut apendisit tanısında ek bir bulgu olarak kullanılabilir. 

Keywords

Akut apandisit, Bükülme açısı, çok kesitli bilgisayarlı tomografi

Can appendix bending angle be an additional finding to detect acute appendicitis on MDCT?

Abstract

Aim: Computed tomography (CT) is frequently used as an imaging modality in the evaluation of acute appendicitis. The most frequently used measurement to detect acute appendicitis is maximal outer diameter of appendix on CT and several studies have reported other CT findings of acute appendicitis, such as thickness of the appendiceal wall, appendiceal wall enhancement, peri-appendiceal free fluid, peri-appendiceal inflammation, peri-appendiceal lymph node, appendicolith and cecal wall thickening. We investigated the value of the appendix bending angle (ABA) as an additional and novel finding in the diagnosis of acute appendicitis. 

Methods: This retrospective study was conducted after the local ethics committee’s approval. 52 consecutive patients who underwent appendectomies were assigned to the study group. The patients, who underwent abdominopelvic CT for any other reason than acute abdomen, were included as control group. 

Results: The mean age of the appendicitis group was 41.9±16.0; male predominance was present (n=32, 61.5%). Peri-appendiceal inflammation was seen in 65.4%, peri-appendiceal lymph node was seen in 73.1% and appendicolith was present in 9.6% of the appendicitis group. The mean ABA was 103.0±15.9 degree in study group and 118.8±23,8 degree in control group respectively (p<0.001). The sensitivity of ABA was calculated as 76.9% and the specificity was 58.3% at 113.15 degree which is the best cut-off point calculated by ROC curve. There was no appendicitis over 142.3 degrees. 

Conclusion: ABA can be used as an additional finding which is decreased in acute appendicitis.

Keywords

Acut appendcitis, Bending angle, Multidedactor computed tomography

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