CT coronal reconstructions aid pediatric appendicitis diagnosis

Adding coronal reformatted images to axial images in MDCT exams can improve the diagnosis of appendicitis in children, radiologists from Gachon University Gil Medical Center in Incheon, South Korea, have determined.

The reconstructions improved sensitivity slightly, between 3% and 6%, in a prospective study conducted by a research team led by Dr. Yoo Jin Kim and described in the January issue of the American Journal of Roentgenology (January 2009, Vol. 192:1, pp. 150-152).

Over a 12-month period commencing October 2005, 61 patients (three months to 15 years of age) who were suspected of having appendicitis underwent CT (Somatom Sensation 16, Siemens Healthcare, Erlangen, Germany) with intravenous contrast. The images were acquired during the portal venous phase (120 kVp, 55 mAs) and included the region from the dome of the diaphragm to the symphysis pubis. Axial and coronal images were reconstructed in 3 x 5-mm sections, at 3-5 mm intervals and with a slice thickness of 0.75 mm.

Two radiologists independently reviewed the CT exams twice on the same day the exams were performed. Each radiologist initially interpreted the axial scans only and assigned confidence scores. With the second review, coronal scans were added and confidence scores were assigned to the combined set of images. Sensitivity and specificity analysis was calculated with the Wilcoxon signed-rank test.

A total of 32 patients were diagnosed with appendicitis. Adding coronal images increased sensitivity to 97%, compared with 91% to 94% sensitivity from the review of only axial images. Specificity did not differ for one reader but decreased from 93% to 90% for the other.

"Because the body habitus of children differs from that of adults and the characteristics of appendicitis in children can differ from those in adults, studies are needed to assess the efficacy of adding multiplanar reformations to MDCT of children," Kim and colleagues wrote.

By Cynthia Keen
AuntMinnie.com staff writer
January 12, 2009

Related Reading

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CT use cuts false positives for appendicitis, March 29, 2008

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