Jussi Haijanen1,2, Suvi Sippola1,2,3, Ville Tammilehto4, Juha Grönroos1,2, Siiri Mäntyoja1,2, Eliisa Löyttyniemi5, Hannele Niiniviita4,6, Paulina Salminen1,2. 1. Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland. 2. Department of Surgery, University of Turku, Turku, Finland. 3. Department of Surgery, Jyväskylä Central Hospital, Jyväskylä, Finland. 4. Department of Radiology, Medical Imaging Centre of Southwest Finland, Turku University Hospital, Turku, Finland. 5. Department of Biostatistics, University of Turku, Turku, Finland. 6. Department of Medical Physics, Turku University Hospital, Turku, Finland.
Abstract
BACKGROUND: Contrast-enhanced CT is the reference standard used in diagnostic imaging for acute appendicitis in adults. The radiation dose has been of concern. This study aimed to assess whether a lower radiation dose would affect the diagnostic accuracy of CT. METHODS: This was a prospective single-centre cohort study of patients (aged over 16 years) with suspected appendicitis evaluated for enrolment in concurrent APPAC II-III trials. The diagnostic accuracy of contrast-enhanced low- and standard-dose CT was compared with study protocols guiding imaging based on BMI; this enabled direct CT imaging comparison only in patients with a BMI below 30 kg/m2. The on-call CT diagnosis was compared with the final clinical diagnosis. RESULTS: Among all 856 patients investigated, the accuracy of low-dose (454 patients) and standard-dose (402 patients) CT in identifying patients with and without appendicitis was 98·0 and 98·5 per cent respectively. In patients with a BMI under 30 kg/m2, respective values were 98·2 per cent (434 patients) and 98·6 per cent (210 patients) (P = 1·000). The corresponding accuracy for differentiating between uncomplicated and complicated acute appendicitis was 90·3 and 87·6 per cent in all patients, and 89·8 and 88·4 per cent respectively among those with a BMI below 30 kg/m2 (P = 0·663). The median radiation dose in the whole low- and standard-dose CT groups was 3 and 7 mSv respectively. In the group with BMI below 30 kg/m2, corresponding median doses were 3 and 5 mSv (P < 0·001). CONCLUSION: Low- and standard-dose CT were accurate both in identifying appendicitis and in differentiating between uncomplicated and complicated acute appendicitis. Low-dose CT was associated with a significant radiation dose reduction, suggesting that it should be standard clinical practice at least in patients with a BMI below 30 kg/m2.
BACKGROUND: Contrast-enhanced CT is the reference standard used in diagnostic imaging for acute appendicitis in adults. The radiation dose has been of concern. This study aimed to assess whether a lower radiation dose would affect the diagnostic accuracy of CT. METHODS: This was a prospective single-centre cohort study of patients (aged over 16 years) with suspected appendicitis evaluated for enrolment in concurrent APPAC II-III trials. The diagnostic accuracy of contrast-enhanced low- and standard-dose CT was compared with study protocols guiding imaging based on BMI; this enabled direct CT imaging comparison only in patients with a BMI below 30 kg/m2. The on-call CT diagnosis was compared with the final clinical diagnosis. RESULTS: Among all 856 patients investigated, the accuracy of low-dose (454 patients) and standard-dose (402 patients) CT in identifying patients with and without appendicitis was 98·0 and 98·5 per cent respectively. In patients with a BMI under 30 kg/m2, respective values were 98·2 per cent (434 patients) and 98·6 per cent (210 patients) (P = 1·000). The corresponding accuracy for differentiating between uncomplicated and complicated acute appendicitis was 90·3 and 87·6 per cent in all patients, and 89·8 and 88·4 per cent respectively among those with a BMI below 30 kg/m2 (P = 0·663). The median radiation dose in the whole low- and standard-dose CT groups was 3 and 7 mSv respectively. In the group with BMI below 30 kg/m2, corresponding median doses were 3 and 5 mSv (P < 0·001). CONCLUSION: Low- and standard-dose CT were accurate both in identifying appendicitis and in differentiating between uncomplicated and complicated acute appendicitis. Low-dose CT was associated with a significant radiation dose reduction, suggesting that it should be standard clinical practice at least in patients with a BMI below 30 kg/m2.
Authors: Jenny Alajääski; Elina Lietzén; Juha M Grönroos; Jukka-Pekka Mecklin; Ari Leppäniemi; Pia Nordström; Tero Rautio; Tuomo Rantanen; Juhani Sand; Hannu Paajanen; Helena Ollila; Paulina Salminen Journal: Int J Colorectal Dis Date: 2022-04-26 Impact factor: 2.796
Authors: Demi Huijgen; Elisabeth M L de Wijkerslooth; Josephine C Janssen; Frédérique H Beverdam; Evert-Jan G Boerma; Jan Willem T Dekker; Sophia Kitonga; Charles C van Rossem; Wilhelmina H Schreurs; Boudewijn R Toorenvliet; Maarten Vermaas; Bas P L Wijnhoven; Anne Loes van den Boom Journal: Int J Colorectal Dis Date: 2022-04-12 Impact factor: 2.796