Evaluation of Acute Appendicitis in Children with Dual-Source Computed Tomography_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHUHong-ji ,  YUJian-qun , PENGLi-qing

Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding?author：

YUJian-qun, Email: cjr.yujianqun@vip.163.com

Keywords：

Acute appendicitis; Location of the appendix; Children; Dual-source CT

DOI：

10.7507/1007-9424.20150229

Video：

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Objective To evaluate the manifestations and diagnostic value of pediatric acute appendicitis with dual-source CT (DSCT). Methods Retrospectively analysis of CT features of 97cases of surgically and pathologically confirmed pediatric acute appendicitis in our hospital were performed. Results Among 97 patients, 7 cases were diagnosed acute simple appendicitis, 20 cases with acute suppurative appendicitis, perforated and gangrenous appendicitis in 58 cases, and appendiceal abscess in 12 cases. According to the location of appendix confirmed by CT, 28 cases of appendicitis could not be clearly manifested, the cohort of the remaining 69 cases were composed of 20 cases (29.0%) with appendix located in pelvic, 15 cases (21.7%) with appendix in front of ileum, 11 cases (15.9%) with appendix behind ileum, 12 cases (17.4%) with appendix behind cecum, 3 cases (4.3%) with appendix below cecum, 1 case (1.5%) with appendix outside of cecum, and 7 cases (10.2%) with appendix located in other positions. CT and three-dimensional reconstruction findings were as followed:swelling enlarged appendix, appendicoliths, periappendiceal fat fuzzy, peritoneal thickening, ileocecal thickening, mesenteric lymphadenopathy, periappendiceal mass, and abdominal or pelvic fluid. The diagnostic rate of acute simple appendicitis with CT was 85.7% (6/7), acute suppurative appendicitis was 80.0% (16/20), perforated and gangrenous appendicitis was 100% (58/58), appendiceal abscess was also 100% (12/12), the overall diagnostic yield was 94.8% (92/97). Conclusion DSCT can well demonstrate the anatomical location of appendix and pathological changes of surrounding tissues, and has higher diagnostic accuracy, provide powerful information for surgeons.

Citation： ZHUHong-ji, YUJian-qun, PENGLi-qing. Evaluation of Acute Appendicitis in Children with Dual-Source Computed Tomography. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(7): 875-878. doi: 10.7507/1007-9424.20150229 Copy

1.	?Karakas SP, Guelfguat M, Leonidas JC, et al. Acute appendicitis in children:comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol, 2000, 30(2):94-98.
2.	Mullins ME, Kircher MF, Ryan DP, et al. Evaluation of suspected appendicitis in children using limited helical CT and colonic contrast material. AJR Am J Roentgenol, 2001, 176(1):37-41.
3.	朱鈞, 單征珊. 多層螺旋CT對小兒急性闌尾炎的診斷分析. 醫學理論與實踐, 2014, 27(24):3329-3330.
4.	令繼文, 趙艷梅. 小兒急性腸系膜淋巴結炎誤診為急性闌尾炎26例分析. 中國普外基礎與臨床雜志, 2012, 19(11):1260-1260.
5.	張昌余, 陳薈竹, 寧剛. 低劑量CT在小兒急性闌尾炎中的應用. 中國CT和MRI雜志, 2014, 12(7):106-108.
6.	羊惠君. 實地解剖學. 北京:人民衛生出版社, 2008:257-258.
7.	Trout AT, Towbin AJ, Zhang B. Journal club:The pediatric appendix:defining normal. AJR Am J Roentgenol, 2014, 202(5):936-945.
8.	Hoecker CC, Billman GF. The utility of unenhanced computed tomography in appendicitis in children. J Emerg Med, 2005, 28(4):415-421.
9.	Yeung KW, Chang MS, Hsiao CP. Evaluation of perforated and nonperforated appendicitis with CT. Clin Imaging, 2004, 28(6):422-427.
10.	Ein SH, Langer JC, Daneman A. Nonoperative management of pediatric ruptured appendix with inflammatory mass or abscess:presence of an appendicolith predicts recurrent appendicitis. J Pediatr Surg, 2005, 40(10):1612-1615.
11.	Kondo NI, Kohno H. Retained appendicolith in an inflamed appendix. Emerg Radiol, 2009, 16(2):105-109.
12.	Shindoh J, Niwa H, Kawai K, et al. Predictive factors for negative outcomes in initial non-operative management of suspected appendicitis. J Gastrointest Surg, 2010, 14(2):309-314.
13.	靳忠民, 蘇虹, 李楠. 應用高頻超聲顯像診斷急性闌尾炎的臨床價值再探討. 中國超聲醫學雜志, 2012, 24(6):169-170.
14.	Lowe LH, Penney MW, Stein SM, et al. Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children:comparison with sonography. AJR Am J Roentgenol, 2001, 176(1):31-35.
15.	Hormann M, Scharitzer M, Stadler A, et al. Ultrasound of the appendix in children:is the child too obese?. Eur Radiol, 2003, 13(6):1428-1431.
16.	Taylor GA. Suspected appendicitis in children:in search of the single best diagnostic test. Radiology, 2004, 231(2):293-295.
17.	Kaiser S, Finnbogason T, Jorulf HK, et al. Suspected appendicitis in children:US and CT-a prospective randomized study. Radiology, 2002, 223(3):633-638.
18.	Rexroad JT. The CT arrowhead sign, Radiology, 2003, 227(1):44-45.
19.	Lane MJ, Liu DM, Huynh MD, et al. Suspected acute appendicitis:nonenhanced helical CT in 300 consecutive patients. Radiology, 1999, 213(2):341-346.
20.	王振芳, 岳學旺, 畢言剛, 等. 急性闌尾炎超聲與64排螺旋CT檢查對比分析. 實用放射學雜志, 2014, 30(7):1154-1156.
21.	張偉耀, 鄧惠玲, 朱峰正. 急性闌尾炎CT檢查的輔助診斷價值及鑒別診斷思路. 中國普外基礎與臨床雜志, 2013, 20(12):1414-1416.
22.	Kharbanda AB, Taylor GA, Bachur RG. Suspected appendicitis in children:rectal and intravenous contrast-enhanced versus intravenous contrast-enhanced CT. Radiology, 2007, 243(2):520-526.
23.	Kaiser S, Finnbogason T, Jorulf HK, et al. Suspected appendicitis in children:diagnosis with contrast-enhanced versus nonenhanced helical CT. Radiology, 2004, 231(2):427-433.
24.	Mun S, Ernst RD, Chen K, et al. Rapid CT diagnosis of acute appendicitis with Ⅳ contrast material. Emerg Radiol, 2006, 12(3):99-102.
25.	蔣雪峰, 張懷欣, 朱玉春. 多層螺旋CT平掃在急性闌尾炎的診斷價值. 中華實用診斷與治療雜志, 2011, 25(58):791-792.

1. ?Karakas SP, Guelfguat M, Leonidas JC, et al. Acute appendicitis in children:comparison of clinical diagnosis with ultrasound and CT imaging. Pediatr Radiol, 2000, 30(2):94-98.
2. Mullins ME, Kircher MF, Ryan DP, et al. Evaluation of suspected appendicitis in children using limited helical CT and colonic contrast material. AJR Am J Roentgenol, 2001, 176(1):37-41.
3. 朱鈞, 單征珊. 多層螺旋CT對小兒急性闌尾炎的診斷分析. 醫學理論與實踐, 2014, 27(24):3329-3330.
4. 令繼文, 趙艷梅. 小兒急性腸系膜淋巴結炎誤診為急性闌尾炎26例分析. 中國普外基礎與臨床雜志, 2012, 19(11):1260-1260.
5. 張昌余, 陳薈竹, 寧剛. 低劑量CT在小兒急性闌尾炎中的應用. 中國CT和MRI雜志, 2014, 12(7):106-108.
6. 羊惠君. 實地解剖學. 北京:人民衛生出版社, 2008:257-258.
7. Trout AT, Towbin AJ, Zhang B. Journal club:The pediatric appendix:defining normal. AJR Am J Roentgenol, 2014, 202(5):936-945.
8. Hoecker CC, Billman GF. The utility of unenhanced computed tomography in appendicitis in children. J Emerg Med, 2005, 28(4):415-421.
9. Yeung KW, Chang MS, Hsiao CP. Evaluation of perforated and nonperforated appendicitis with CT. Clin Imaging, 2004, 28(6):422-427.
10. Ein SH, Langer JC, Daneman A. Nonoperative management of pediatric ruptured appendix with inflammatory mass or abscess:presence of an appendicolith predicts recurrent appendicitis. J Pediatr Surg, 2005, 40(10):1612-1615.
11. Kondo NI, Kohno H. Retained appendicolith in an inflamed appendix. Emerg Radiol, 2009, 16(2):105-109.
12. Shindoh J, Niwa H, Kawai K, et al. Predictive factors for negative outcomes in initial non-operative management of suspected appendicitis. J Gastrointest Surg, 2010, 14(2):309-314.
13. 靳忠民, 蘇虹, 李楠. 應用高頻超聲顯像診斷急性闌尾炎的臨床價值再探討. 中國超聲醫學雜志, 2012, 24(6):169-170.
14. Lowe LH, Penney MW, Stein SM, et al. Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children:comparison with sonography. AJR Am J Roentgenol, 2001, 176(1):31-35.
15. Hormann M, Scharitzer M, Stadler A, et al. Ultrasound of the appendix in children:is the child too obese?. Eur Radiol, 2003, 13(6):1428-1431.
16. Taylor GA. Suspected appendicitis in children:in search of the single best diagnostic test. Radiology, 2004, 231(2):293-295.
17. Kaiser S, Finnbogason T, Jorulf HK, et al. Suspected appendicitis in children:US and CT-a prospective randomized study. Radiology, 2002, 223(3):633-638.
18. Rexroad JT. The CT arrowhead sign, Radiology, 2003, 227(1):44-45.
19. Lane MJ, Liu DM, Huynh MD, et al. Suspected acute appendicitis:nonenhanced helical CT in 300 consecutive patients. Radiology, 1999, 213(2):341-346.
20. 王振芳, 岳學旺, 畢言剛, 等. 急性闌尾炎超聲與64排螺旋CT檢查對比分析. 實用放射學雜志, 2014, 30(7):1154-1156.
21. 張偉耀, 鄧惠玲, 朱峰正. 急性闌尾炎CT檢查的輔助診斷價值及鑒別診斷思路. 中國普外基礎與臨床雜志, 2013, 20(12):1414-1416.
22. Kharbanda AB, Taylor GA, Bachur RG. Suspected appendicitis in children:rectal and intravenous contrast-enhanced versus intravenous contrast-enhanced CT. Radiology, 2007, 243(2):520-526.
23. Kaiser S, Finnbogason T, Jorulf HK, et al. Suspected appendicitis in children:diagnosis with contrast-enhanced versus nonenhanced helical CT. Radiology, 2004, 231(2):427-433.
24. Mun S, Ernst RD, Chen K, et al. Rapid CT diagnosis of acute appendicitis with Ⅳ contrast material. Emerg Radiol, 2006, 12(3):99-102.
25. 蔣雪峰, 張懷欣, 朱玉春. 多層螺旋CT平掃在急性闌尾炎的診斷價值. 中華實用診斷與治療雜志, 2011, 25(58):791-792.

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Evaluation of Acute Appendicitis in Children with Dual-Source Computed Tomography

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