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文献考察１）：CTは婦人科疾患との鑑別診断に極めて有用．
Obstet Gynecol. 1999 Mar;93(3):417-21.
Helical computed tomography in differentiating appendicitis and acute gynecologic conditions.
Rao PM, Feltmate CM, Rhea JT, Schulick AH, Novelline RA.
OBJECTIVE: To determine the accuracy and effect of helical computed tomography (CT) in women clinically suspected of having either appendicitis or an acute gynecologic condition. METHODS: One hundred consecutive nonpregnant women suspected of having appendicitis or an acute gynecologic condition prospectively had helical CT. Interpretations were correlated with surgical and pathologic findings (41 cases) and clinical follow-up for at least 2 months (59 cases). The accuracy for confirming or excluding both appendicitis and acute gynecologic conditions was determined. The effect on patient care was determined by comparing pre-CT plans with actual treatment. RESULTS: Thirty-two women had appendicitis, 15 had acute gynecologic conditions, 27 had other specific diagnoses, and 26 had nonspecific abdominal pain. For diagnosing appendicitis or acute gynecologic conditions, CT had 100% and 87% sensitivity, 97% and 100% specificity, 94% and 100% positive predictive value, 100% and 98% negative predictive value, and 98% and 98% accuracy, respectively. After CT was done, 36 planned hospital admissions, 25 planned hospital observations, and six planned appendectomies were deferred; six women had alternative surgical procedures on the basis of CT results. One patient had an unnecessary appendectomy on the basis of CT findings. CONCLUSION: Helical CT is an excellent imaging option for differentiating appendicitis from most acute gynecologic conditions. PMID: 10074991
文献考察２）：急性虫垂炎の診断に単純CTのsensitivityは66％と低く，経静脈的造影CTでかなり向上する（90％）．単純CTと造影CTの両方を撮影してもsensitivityは向上しない．
Radiology. 2004 May;231(2):427-33. Epub 2004 Mar 18.
Suspected appendicitis in children: diagnosis with contrast-enhanced versus nonenhanced Helical CT.
Kaiser S, Finnbogason T, Jorulf HK, Soderman E, Frenckner B.
PURPOSE: To compare the diagnostic accuracy of limited-area (lower abdominal) nonenhanced helical computed tomography (CT), intravenous contrast material-enhanced helical CT of the entire abdomen, and the combination of both. MATERIALS AND METHODS: Three hundred six children suspected of having appendicitis, who were previously included in a prospective study, underwent limited-area nonenhanced helical CT of the lower abdomen and contrast-enhanced CT of the entire abdomen. No oral or rectal contrast material was administered. The CT scans were retrospectively reviewed by three independent readers both separately and together. The readers were blinded to all clinical information and to the results of previous ultrasonographic and CT examinations. Final diagnoses were established on the basis of surgical, histopathologic, or clinical follow-up findings. The Pearson chi(2) test was performed to compare values between groups. The Student two-sample t test was performed to determine statistically significant differences in age and sex. RESULTS: One hundred twenty-nine patients (42%) had appendicitis. Readers diagnosed appendicitis with 66% pooled sensitivity and 96% pooled specificity with limited-area nonenhanced CT. With contrast-enhanced CT of the entire abdomen, appendicitis was diagnosed with 90% pooled sensitivity and 94% pooled specificity. With both sequences together, readers diagnosed appendicitis with 90% pooled sensitivity and 94% pooled specificity. The difference between the sensitivity of limited-area nonenhanced CT and that of contrast-enhanced CT was statistically significant (P <.001 conclusion: sensitivity of helical ct for suspected appendicitis in children improved significantly with abdominal contrast-enhanced compared limited-area nonenhanced ct. no further improvement was achieved the combination both sequences comparison to that alone.pmid:> |
