Imaging confirms or excludes the presence of gangrenous appendicitis with high sensitivity and specificity.
Dual-energy CT with virtual monoenergetic and iodine overlay imaging accurately confirms or excludes the presence of gangrenous appendicitis, according to a study published in the American Journal of Roentgenology.
Researchers from Canada performed a retrospective study to determine if the use of dual-energy spectral techniques in CT can improve accuracy in the diagnosis of acute gangrenous appendicitis.
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A total of 209 patients with a pathologic diagnosis of appendicitis were included in the study. Two board-certified abdominal radiologists reviewed 120-kV simulated images, 40-keV virtual monoenergetic images, and color-coded iodine overlay images.
The results showed 44 patients (21.0%) had histopathologic results positive for gangrenous appendicitis. Other findings were:
|Sensitivity||100% (44/44)||100% (44/44)||22.7% (10/44)|
|Specificity||81.2% (134/165)||80.0% (132/165)||96.4% (159/165)|
|PPV||58.7% (44/75)||57.1% (44/77)||62.5% (10/16)|
|NPV||100% (134/134)||100% (132/132)||82.4% (159/193)|
All cases of gangrenous appendicitis had true-positive results of virtual monoenergetic and iodine overlay imaging. There were no false-negative results of virtual monoenergetic or iodine overlay imaging.
The researchers concluded that in cases of suspected appendicitis, dual-energy CT that includes virtual monoenergetic and iodine overlay imaging is accurate for confirming and excluding the presence of gangrenous appendicitis with high sensitivity and specificity.