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JARMS. 2013; 5(2): 191-198


Comparative Study of Ultrasonography (USG) Versus Computed Tomography (CT) in Clinically Suspected Cases of Acute Appendicitis: Retrospective Study of 100 Cases

*Sudhir Sachar, Alok Maheshwari, Subhash Balian, Sunder Goyal, Saurabh Sachar, Snigdha Goyal.

Abstract
A study to compare the accuracy of ultrasonography (USG) and helical computed tomography (CT) for diagnosis of acute appendicitis in male patients with suspected acute appendicitis was carried out in a medical college hospital. In this retrospective study, 110 male patients with clinical diagnosis of acute appendicitis were included. All patients were examined with USG (graded/gradual compression technique with posterior manual compression over the most painful area as pointed by patient using his index finger) and CT (focused unenhanced & post-contrast helical CT - 5-mm section thickness). CT was performed from the L3 vertebral body to the pubic symphysis. Only three patients were given colonic contrast medium and all were given I/V contrast after unehancced CT. Main USG features for diagnosing acute appendicitis were an incompressible appendix with a transverse outer diameter of ≥7 with incompressible periappendicular inflamed fat with or without an appendicolith. Main CT features for diagnosing acute appendicitis were the identification of an appendix with a transverse outer diameter of ≥ 6 mm with associated periappendiceal inflammatory changes. The results, independently reported, were correlated with histopathologic findings. USG and CT were done in 100 cases as 5 cases did not give consent for imaging and surgery due to fear and left hospital and other 5 cases which did not undergo imaging were critically ill with Alvarado score ≥ 9 and all had acute appedicitis on surgery. 25 cases had diseases of other organs on imaging. So only in 75 cases appendectomy after imaging was done and all 75 specimens were sent for histopathology. 74 patients actually on CT and 72 on USG were correctly diagnosed before surgery as acute appendicitis cases.The sensitivity of CT and USG was 98% (74/75) and 96% (72/75), respectively.Unenhanced or enhanced focused helical CT and graded compression USG with posterior manual compression have almost similar accuracy for the diagnosis of acute appendicitis after adjuvant use of performing USG over the most painfull area as pointed by patient using his index finger.

Key words: Ultrasonography (USG), Computed Tomography (CT), Acute Appendicitis.



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