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Choi: Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography
Abdominal Radiology
Original Article

Journal of the Korean Society of Radiology 2011; 65(1): 69-76.

Published online: 31 July 2011

DOI: https://doi.org/10.3348/jksr.2011.65.1.69

Differentiation of Acute Perforated from Non-Perforated Appendicitis: Usefulness of High-Resolution Ultrasonography

Gyo Chang Choi, MD

Department of Radiology, Soonchunhyang University Gumi Hospital, Gumi, Korea.

Corresponding author: Gyo-Chang Choi, MD. Department of Radiology, Soonchunhyang University Gumi Hospital, 250 Gongdan-dong, Gumi 730-706, Korea. Tel. 82-54-468-9114, Fax. 82-54-463-7504, cgc3@schmc.ac.kr

Received 30 April 2011       Accepted 20 June 2011

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

To evaluate the usefulness of high-resolution ultrasonography (US) for the differentiation of acute perforated appendicitis from non-perforated appendicitis.

Materials and Methods

The high-resolution US features in 96 patients (49 males, 47 females; mean age, 33.8 years; age range, 4-80 years) with pathologically proven acute appendicitis were evaluated. The following US findings were evaluated for differentiation of acute perforated appendicitis from non-perforated appendicitis: circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths. The sensitivity and specificity of the US features in the diagnosis of acute perforated appendicitis were calculated.

Results

All of the US findings, except for appendicoliths, were significantly more common in the acute perforated appendicitis group (p < 0.001). The sensitivity of circumferential loss of the echogenic submucosal layer, periappendiceal fluid collection, disruption of the serosal layer, asymmetrical wall thickening, maximum overall diameter > 10.5 mm, and the presence of appendicoliths was 85.4, 73.2, 68.3, 70.7, 80.5, and 36.6%, respectively, while the specificity was 65.5, 89.1, 96.4, 98.2, 81.8, and 80.0%, respectively.

Conclusion

High-resolution US was found to be useful for differentiating acute perforated appendicitis from non-perforated appendicitis.

Keywords: Appendicitis, Appendix, Appendix, US, Ultrasound (US), Technology

Figures and Tables

Fig. 1

A 78-year-old man with acute perforated appendicitis. The high-resolution longitudinal US image shows circumferential loss of the echogenic submucosal layer.

Note.-US = ultrasonography
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Fig. 2

A 76-year-old woman with acute perforated appendicitis. The high-resolution US image shows anechoic or low echoic periappendiceal fluid collection (arrows).

Note.-US = ultrasonography
jksr-65-69-g002
Fig. 3

A 10-year-old girl with acute perforated appendicitis. The high-resolution longitudinal US image shows disruption of the serosal layer (arrows).

Note.-US = ultrasonography
jksr-65-69-g003
Fig. 4

A 40-year-old woman with acute perforated appendicitis. The high-resolution transverse US image shows asymmetrical wall thickening. The posterior wall (arrows) is more than 1.5 mm thicker than the anterior wall (arrowheads).

Note.-US = ultrasonography
jksr-65-69-g004
Fig. 5

A 42-year-old woman with acute non-perforated appendicitis. The high-resolution transverse US image shows an arc-like surface echogenic focus with a posterior acoustic shadowing in the lumen of the appendix.

Note.-US = ultrasonography
jksr-65-69-g005
Table 1

Sex and Age of Patients with Perforated and Non-perforated Appendicitis

jksr-65-69-i001

Note.-*Values are the mean ± standard deviation.

†Chi-square test.

‡Student t-test

Table 2

Appendiceal US Measurement of Patients with Perforated and Non-perforated Appendicitis

jksr-65-69-i002

Note.-†Student t-test.

US = ultrasonography

Table 3

Prevalence of US Findings Indicating Appendiceal Perforation

jksr-65-69-i003

Note.-Numbers in parentheses were used to calculate percentages.

*Chi-squre test.

US = ultrasonography

Table 4

Sensitivity and Specificity Analysis of US Findings of Perforated Appendicitis among Groups

jksr-65-69-i004

Note.-Group 1: ≥ 2 among circumferential loss of echogenic submucosa, periappendiceal fluid collection, disruption of serosa, asymmetrical wall thickening, and maximum overall diameter > 10.5 mm; group 2 : ≥ 3 among circumferential loss of echogenic submucosa, periappendiceal fluid collection, disruption of serosa, asymmetrical wall thickening, and maximum overall diameter > 10.5 mm; group 3 : ≥ 4 among circumferential loss of echogenic submucosa, periappendiceal fluid collection, disruption of serosa, asymmetrical wall thickening, and maximum overall diameter > 10.5 mm.

CI = confidence interval

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