Joo sung Sun MD, Presenter: Nothing to Disclose

Jai Keun Kim MD, Abstract Co-Author: Nothing to Disclose

Jei Hee Lee MD, Abstract Co-Author: Nothing to Disclose

Hyun Woo Noh MD, Abstract Co-Author: Nothing to Disclose

Min Ji Kim MD, Abstract Co-Author: Nothing to Disclose

Young Gi Min MD, Abstract Co-Author: Nothing to Disclose

Jun Man Kim MD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

To evaluate the usefulness of CT scan in patients of equivocal clinical suspicion based on MANTRELS score for acute appendicitis.

We retrospectively reviewed the CT scans and medical records of 207 patients who presented with symptoms of acute appendicitis. We classified the patients into low (MANTRELS score 0-3), intermediate (MANTRELS score 4-7), and high (MANTRELS score 8-10) probability group of acute appendicitis by using MANTRELS score {total sum of 10 points. 1 point in each items as follows; migration of pain from center to RLQ, anorexia or acetonuria, nausea with vomiting, rebound tenderness, elevated body temperature > 38˚c, shifted WBC count (>75% neutrophils) and 2 point in each items as follows; tenderness in the right lower quadrant, leukocytosis (>10,400 cells/mm3)}. A five-point scale of CT grade was used: grade 0, normal appendix; grade 1, probably normal appendix; grade 2, probable appendicitis; grade 3, appendicitis; grade 4, definite appendicitis.

A final diagnosis of acute appendicitis was confirmed in 133 patients (Pts) by appendectomy and pathology. In the rest of 74 Pts, appendicitis was ruled out by surgery (4 Pts), other surgery (8 Pts), or clinical follow-up (62 Pts). CT Grade of 0-2 was used as a negative predictor to rule out appendicitis and CT grade of 3-4 was used as a positive predictor. A positive and negative predictive value of CT scan was 98.4% and 87.8%, respectively. The sensitivity and specificity of CT scan was 92.5% and 97.3%, respectively. The 25% and 82% of Pts were diagnosed with appendicitis in low and high probability group, respectively. In intermediate group, 64% of Pts were diagnosed with appendicitis. No inter-sexual difference was noted in low and high probability group. However in intermediate probability group, appendicitis was rule out in 43% (33/76) in female and 26% (16/61) in male Pts and significant difference was noted (Ρ<0.05). The sensitivity, specificity, positive and negative predictive value of CT scan in female of intermediate group was all 100%.

We suggest that the CT scan is essential for women who presents with intermediate symptoms of acute appendicitis to avoid negative appendectomy.

Sun, J, Kim, J, Lee, J, Noh, H, Kim, M, Min, Y, Kim, J, et al, , Usefulness of Computed Tomography (CT) Scan in Patients of Intermediately Suspected Acute Appendicitis Based on MANTRELS Score.  Radiological Society of North America 2005 Scientific Assembly and Annual Meeting, November 27 - December 2, 2005 ,Chicago IL. http://archive.rsna.org/2005/4416466.html