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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) |
Accuracy | 85.2% | 84.2% | 77.5% |
Interobserver agreement | 0.99 | 0.99 | 0.93 |
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.
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