Diagnostic accuracy using low-dose versus standard radiation dose CT in suspected acute appendicitis: prospective cohort study
| Autor: | Suvi Sippola, Ville Tammilehto, Eliisa Löyttyniemi, Jussi Haijanen, Siiri Mäntyoja, Juha Grönroos, Hannele Niiniviita, Paulina Salminen |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Contrast Media Diagnostic accuracy Appendix Radiation Dosage Body Mass Index Cohort Studies Young Adult Medical imaging medicine Humans Prospective cohort study Aged Aged 80 and over business.industry Radiation dose Low dose Middle Aged Appendicitis medicine.disease Acute appendicitis Female Surgery Radiology Tomography X-Ray Computed business Cohort study |
| Zdroj: | British Journal of Surgery. 108:1483-1490 |
| ISSN: | 1365-2168 0007-1323 |
| Popis: | 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 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. |
| Databáze: | OpenAIRE |
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