АНАЛИЗ УЛЬТРАЗВУКОВЫХ СКАНОВ ЧЕРВЕОБРАЗНОГО ОТРОСТКА У ПАЦИЕНТОВ С ПОДОЗРЕНИЕМ НА ОСТРЫЙ АППЕНДИЦИТ

Abstract

Objective. Comprehensive assessment of structural changes in the appendix vermiformis (AV), visualized during its ultrasound examination in patients with suspected acute appendicitis (AA), finding parallels between the ultrasound image of changes in the AV and histological findings, clinical diagnosis, and patient treatment method. Material and methods. 136 patients examined at the Ultrasound Department were admitted on an emergency basis due to suspicion of AA: 94 (69.1%) were women and 42 (30.9%) were men. The group of patients who were operated consisted of 65 (44.1%) patients, while the non-operated group consisted of 71 (55.9%) patients. All patients underwent ultrasound of the right iliac area, and ultrasound scans of the AV were saved and analyzed retrospectively. Each ultrasound scan was analyzed based on the following criteria: vertical diameter of AV, cross-sectional area of AV, degree of deformation of AV, thickness of each layer of AV separately, total wall thickness of AV, degree of differentiation of individual layers of AV, contrast of AV wall layers, diameter of AV lumen, contents of the AV lumen, presence of echogenicity in the contents of the AV lumen. Results. Among the studied parameters of AV, four criteria showed correlation with histological findings, clinical diagnosis, and patient treatment method at p≤0.05: vertical diameter, cross-sectional area, muscular layer thickness, contents in the lumen. The criterion "vertical diameter of AV 6 mm or more" had a sensitivity of 84%, specificity of 66%, and accuracy of 77% for histological findings; for clinical diagnosis – 75%, 78%, 76%, respectively; for surgery probability prediction – 81%, 57%, 70%, respectively. The criterion "cross-sectional area more than 30 mm2" had a sensitivity of 92%, specificity of 57%, and accuracy of 78% for histological findings; for clinical diagnosis – 75%, 78%, 76%, respectively; for surgery probability prediction – 87%, 42%, 65%, respectively. The criterion "muscular layer thickness 0.7 mm or more" had a sensitivity of 65%, specificity of 71%, and accuracy of 67% for histological findings; for clinical diagnosis – 42%, 76%, 56% respectively; for surgery probability prediction – 32%, 86%, 65%. When analyzing the effectiveness of using criteria for appendicitis, patients were divided into groups based on the diameter of the AV: patients with AV diameter up to 6 mm, patients with AV diameter 6-8 mm, patients with AV diameter more than 8 mm. The implementation of additional criteria showed its effectiveness in the group with AV diameter 6-8 mm: the accuracy of diagnosing phlegmonous AA increases based on this additional criteria. Conclusions. Based on ultrasound data, it is possible to distinguish patients with gangrenous and phlegmonous AA from patients with other forms of AA, and from patients without AA. During the study, the effectiveness of using additional criteria for AA such as cross-sectional area of AV, contents in the lumen, muscular layer thickness in AV diameter from 6 to 8 mm was revealed. The use of ultrasound criteria alone is not sufficient to determine the treatment strategy for the patient and should be combined with the clinical presentation of the disease.