Predictive value of sphericity index and other multidetector computed tomography findings in perforated acute appendicitis

BACKGROUND: Early radiological prediction and diagnosis of perforated acute appendicitis remain controversial. In the current study, it was aimed to examine the predictive value of multidetector computed tomography (MDCT) findings in perforated acute appendicitis.
METHODS: The patients (n=542) who underwent appendectomy between January 2019 and December 2021 were retrospectively evaluated. The patients were divided into two groups as non-perforated appendicitis and perforated appendicitis. Preoperative abdom-inal MDCT findings, appendix sphericity index (ASI) scores, and laboratory findings were evaluated.
RESULTS: The sample consisted of 427 cases in the non-perforated group and 115 cases in the perforated group, with a mean age of 33.88±12.84 years. The mean time until admission was 2.06±1.43 days. Appendicolith, free fluid, wall defect, abscess, free air, and retroperitoneal space (RPS) involvement were all found to be significantly higher in the perforated group (P<0.001). The mean long axis, short axis, and ASI values were found to be higher in the perforated group (P<0.001; P=0.004; and P<0.001, respectively). C-reac-tive protein (CRP) was found to be significantly higher in the perforated group (P=0.008), but the mean white blood count was found to be similar between the groups (P=0.613). Among MDCT findings, free fluid, wall defect, abscess, high CRP, long axis, and ASI were observed to be predictive values for perforation. According to receiver operating characteristic analysis, ASI had a cut-off value of 1.30, a sensitivity of 80.87%, and a specificity of 93.21%.
CONCLUSION: MDCT findings, namely, appendicolith, free fluid, wall defect, abscess, free air, and RPS involvement are significant findings for perforated appendicitis. With a high sensitivity and specificity, the ASI appears to be a key predictive parameter for perfo-rated acute appendicitis.

Perfore akut apandisitte sferisite indeksi ve diðer multidedektör bilgisayarlý tomografi bulgularýnýn prediktif deðeri

AMAÇ: Perfore akut apandisitin erken radyolojik tahmini ve teþhisi hala tartýþmalýdýr. Bu çalýþmada, multidedektör bilgisayarlý tomografi (MDBT) bulgularýnýn perfore akut apandisitte prediktif deðerinin incelenmesi amaçlandý.
GEREÇ VE YÖNTEM: Ocak 2019 – Aralýk 2021 arasýnda apendektomi ameliyatý yapýlan hastalar (n=542) retrospektif olarak deðerlendirildi. Hastalar non-perfore ve perfore olmak üzere iki gruba ayrýldý. Preoperatif abdominal MDBT bulgularý, apendiks sferisite indeksi (ASÝ) ve laboratuvar bulgularý deðerlendirildi.
BULGULAR: Non-perfore grupta 427, perfore grupta 115 olgu vardý ve tüm olgularýn yaþ ortalamasý 33.88±12.84 idi. Baþvuruya kadar geçen ortalama süre 2.06±1.43 gündü. Perfore olan grupta apendikolit, serbest sývý, duvar defekti, apse, serbest hava ve retroperitoneal alan (RPA) tutulumu oraný non-perfore gruba göre anlamlý ölçüde daha yüksek bulundu (p<0.001). Perfore grubun ortalama uzun aks, kýsa aks, ASÝ deðerleri non-perfore gruba göre daha yüksek bulundu (sýrasýyla; p<0.001; p=0.004; p<0.001). Perfore grupta CRP anlamlý ölçüde yüksek iken (p=0.008) ortalama WBC her iki grupta benzerdi (p=0.613). MDBT bulgularýndan serbest sývý, duvar defekti, apse, CRP yüksekliði, uzun aks ve ASÝ’nin perfo-rasyon için prediktif deðerler olduðu gözlendi. ROC analizi ile ASÝ’nin kestirim deðeri 1.30, sensitivitesi %80.87, spesifitesi %93.21 idi.
TARTIÞMA: Multidedektör BT bulgularýndan apendikolit, serbest sývý, duvar defekti, apse, serbest hava ve RPA tutulumu perfore apandisitte anlamlý bulgulardýr. Apendiks sferisite indeksi yüksek sensitivite ve spesifisite ile akut apandisit perforasyonunda önemli bir prediktif parametredir.