Contribution of the appendix sphericity index in predicting perforated acute appendicitis

BACKGROUND: The purpose of the present study was to investigate the diagnostic value of the appendiceal sphericity index (SI) and appendix diameters in cases of perforated and non-perforated acute appendicitis.
METHODS: Eighty-one patients who underwent computed tomography (CT) in our clinic and who were diagnosed with acute appendicitis after histopathological assessment between January 2015 and August 2017 were included in the study. According to their histopathological findings, the patients were divided into two groups: perforated and non-perforated appendicitis. The patients’ CT images were re-evaluated with respect to perforation. Long axis and short axis of the appendix and the SI obtained by their proportions were calculated from the appropriate plane on CT. Their parameters and other CT findings as defined in the current literature were analyzed for statistical significance in the detection of perforation.
RESULTS: The perforated and non-perforated appendicitis groups consisted of 20 and 61 patients, respectively. For wall defect, abscess, extraluminal air, free fluid, and appendicolith, the sensitivity values were 25%, 15%, 25%, 55%, and 50%, respectively, and the specificity values were 100%, 100%, 100%, 77%, and 70.5%, respectively. Sensitivity and specificity for the SI and long axis of the appendix were calculated as 85% and 90% and 85.2% and 73.8%, respectively (p<0.001).
CONCLUSION: Although there are many findings with high specificity in the diagnosis of perforation, their sensitivity is very low when evaluated separately. We consider that the measurement of long-axis length with high sensitivity and the evaluation of SI with high specificity and sensitivity will contribute significantly to the diagnosis of perforation.

Akut apandisitte apendiks sferisite indeksinin perforasyon tahmininde tanýya katkýsý

AMAÇ: Çalýþmamýzda perfore ve nonperfore apandisit olgularýnda apendiks sferisite indeksi ve apendiks çaplarýnýn ve perforasyon tespitinde tanýya katkýsýný deðerlendirdik.
GEREÇ VE YÖNTEM: Çalýþmaya Ocak 2015–Aðustos 2017 arasýnda kliniðimizde yapýlan bilgisayarlý tomografi (BT) sonucu apandisit ile uyumlu olan ve histopatolojik sonucu apandisit olarak kanýtlanmýþ 81 hasta alýndý. Histopatolojik sonuçlarýna göre hastalar perfore ve nonperfore apandisit olmak üzere iki gruba ayrýldý. Hastalarýn BT görüntüleri perforasyon açýsýndan tekrar deðerlendirildi. Uygun BT planýndan apendiks uzun aksý, kýsa aksý ve bunlarýn oranlanmasý ile elde edilen sferisite indeksi hesaplandý. Her bulgunun duyarlýlýðý ve özgüllüðü perforasyon tanýsýnda literatürde tanýmlanmýþ diðer BT bulgularý ile birlikte gruplar arasýnda istatistiksel olarak analiz edildi.
BULGULAR: Perfore grup 20, nonperfore grup 61 hastadan oluþmaktaydý. Duvar defekti, apse, ekstralüminal hava, serbest sývý ve apendikolit bulgularý için sensitivite deðerleri sýrasýyla %25, %15, %25, %55, %50, spesifite deðerleri sýrasýyla %100, %100, %100, %77, %70.5 iken, sferisite indeksi ve apendiks uzun aksý için sensitivite deðerleri sýrasýyla %85 ve %90 spesifite deðerleri sýrasýyla %85.2 ve %73.8 olarak hesaplandý (p<0.001).
TARTIÞMA: Perforasyon tanýsýnda yüksek özgüllüðe sahip çok sayýda bulgu olmasýna raðmen bulgular ayrý ayrý deðerlendirildiðinde duyarlýlýk oldukça düþüktür. Uzun aks ölçümünün yüksek duyarlýlýk; sferisite indeksi deðerlendirilmesinin ise yüksek duyarlýlýk ve özgüllük ile perforasyon tanýsýna önemli katký saðlayabileceðini düþünmekteyiz.