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1214: Added Value of Color Doppler Ultrasonography in Acute Appendicitis: Preliminary Study for Prediction of Perforation
Abstracts 1213 Comparison of US and CT in the Classifications of Types of Nasal Fractures Heung Cheol Kim, Dept. of Radiology, Hallym Univ. Hospital, Chuncheon, Korea Purpose: The aim of the study was to compare the sonographic and CT classifications of the type of nasal fractures. Materials and Methods: 72 patients with nasal trauma were investigated. All patients underwent US (5--12 MHz linear array transducer) and axial CT scans. The fractures classifications by US findings were compared with the classifications by CT findings. Nasal fractures were classified into the followings. Type 1: no fracture or fracture without displacement. Type 2: fracture with unilateral displacement / without posterior displacement. Type 3: fracture with bilateral displacement / without posterior displacement. Type 4: fracture with posterior displacement / without lateral displacement. Type 5: fracture with bilateral and posterior displacement. The ?2 test and values were used to compare the results between the 2 diagnostic tools (US and CT). Results: The nasal bone fractures classified by CT findings were type 1(31 cases, 43%), type 2(19 cases, 26%), type 3(14 cases, 19%), type 4(5 cases, 6% ), type 5(3 cases, 4%) and by US findings were type 1(22 cases, 30%), type 2(27 cases, 37%), type 3(11 cases, 15%), type 4(6 cases, 8%), type 5(6 cases, 8%). The test showed a good correspondence between 2 diagnostic tools ( ⫽0.563). The ?2 test showed no statistical significant difference was found between US and CT in the classifications of the nasal bone fracture (p⫽0.358). Conclusion: Ultrasonic investigation of the nasal bone is a useful way to classify the fracture types that provides similar results to CT.
1214 Added Value of Color Doppler Ultrasonography in Acute Appendicitis: Preliminary Study for Prediction of Perforation Min Yeong Kim, Department of Radiology, Korea University Ansan Hospital, Korea Sang Hoon Cha, Department of Radiology, Korea University Ansan Hospital, Korea Hwan Hoon Chung, Department of Radiology, Korea University Ansan Hospital, Korea Seung Hwa Lee, Department of Radiology, Korea University Ansan Hospital, Korea Bo Kyung Je, Department of Radiology, Korea University Ansan Hospital, Korea Purpose: To investigate the added value of color Doppler ultrasonography in patients with acute appendicitis, focusing on risk of perforation. Materials & Methods: On retrospective review of ultrasonography with surgically-proven acute appendicitis, fourteen patients underwent simultaneous color Doppler exams. All ultrasonographic exams were analyzed with maximal diameter, maximal mural thickness, intraluminal contents, loss of mural integrity, periappendiceal fat echogenicity, amount of loculated periappendiceal fluid/abscess and the color signal patterns in whole appendix. In each gray-scale ultrasonography and added color Doppler exams, the confidence for probability of perforation was graded using a four point scale (1, no risk; 2, low risk; 3, high
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risk; 4, definite perforation) and compared with surgical and pathologic reports as reference standards. Results: Eight of 14 patients were in high risk of perforation including 5 gangrenous and 3 perforated appendicitis on reference standards. The amount of loculated periappendiceal fluid or abscess was not enough to be seen on ultrasonography. Excessively increased periappendiceal fat echogenicity was highly specific regardless of color Doppler ultrasonography but evident in only two patients. Color Doppler ultrasonography was helpful in 8 patients with increased accuracy and confidence for risk of perforation and two specific findings were focal loss of color signal in background increased blood flow of appendix and absence of color signal in the entire appendix. There was no significant association between other characteristics and risk of perforation. Conclusion: Adding color Doppler ultrasonographic exams improved predictability of perforation with increased accuracy and confidence during routine gray-scale ultrasonography of acute appendicitis. 1215 Where is Ultrasonographics Exams for Acute Appendicitis in MDCT Era? - Direct Comparison of Ultrasonography with MDCT in Same Patients Min Yeong Kim, Department of Radiology, Korea University Ansan Hospital, Korea Sang Hoon Cha, Korea University Ansan Hospital, Korea University College of Medicine, Korea Hwan Hoon Chung, Department of Radiology, Korea University Ansan Hospital, Korea Seung Hwa Lee, Korea University Hospital, Korea Bo Kyung Je, Department of Radiology, Korea University Ansan Hospital, Korea Purpose: To directly compare of diagnostic accuracy and confidence of ultrasonography with MDCT for acute appendicitis with/without complication in same patients and to analyze affecting factors to diagnostic performance. Learning Objects: To understand different characteristics between ultrasonography and MDCT for evaluation of appendiceal abnormalities. To analyze the false negative results of MDCT in acute appendicitis despite correct ultrasonographic diagnoses. To evaluate added values of color Doppler exams for diagnosis of acute appendicitis and complication. To help with choosing the first diagnostic modality between ultrasonography and MDCT. To consider surgeons’ views of diagnostic modalities. Conclusion: Though MDCT is accurate and surgeons’ preference, ultrasonographic exam must be considered the first diagnostic modality in patients with acute appendicitis. 1216 Ultrasound Findings of Torn Greater Omentum Van Nghiep Nguyen, MD, Vietnam Vu Quang Duong, MD, Vietnam Hung Thien Nguyen, MD, Vietnam Hai Thanh Phan, MD, Vietnam Purpose: To report 2 rare cases of hemoperitoneum caused by torn greater omentum. Materials and Methods: Abdominal ultrasound first , and then abdominal punction and surgery confirmed. Results: 2 male patients 32-44 y.o were seen with diffuse abdominal pain of 24-48 hours duration. They had no fever, nausea, or
1214 Added Value of Color Doppler Ultrasonography in Acute Appendicitis: Preliminary Study for Prediction of Perforation Min Yeong Kim, Department of Radiology, Korea University Ansan Hospital, Korea Sang Hoon Cha, Department of Radiology, Korea University Ansan Hospital, Korea Hwan Hoon Chung, Department of Radiology, Korea University Ansan Hospital, Korea Seung Hwa Lee, Department of Radiology, Korea University Ansan Hospital, Korea Bo Kyung Je, Department of Radiology, Korea University Ansan Hospital, Korea Purpose: To investigate the added value of color Doppler ultrasonography in patients with acute appendicitis, focusing on risk of perforation. Materials & Methods: On retrospective review of ultrasonography with surgically-proven acute appendicitis, fourteen patients underwent simultaneous color Doppler exams. All ultrasonographic exams were analyzed with maximal diameter, maximal mural thickness, intraluminal contents, loss of mural integrity, periappendiceal fat echogenicity, amount of loculated periappendiceal fluid/abscess and the color signal patterns in whole appendix. In each gray-scale ultrasonography and added color Doppler exams, the confidence for probability of perforation was graded using a four point scale (1, no risk; 2, low risk; 3, high
S157
risk; 4, definite perforation) and compared with surgical and pathologic reports as reference standards. Results: Eight of 14 patients were in high risk of perforation including 5 gangrenous and 3 perforated appendicitis on reference standards. The amount of loculated periappendiceal fluid or abscess was not enough to be seen on ultrasonography. Excessively increased periappendiceal fat echogenicity was highly specific regardless of color Doppler ultrasonography but evident in only two patients. Color Doppler ultrasonography was helpful in 8 patients with increased accuracy and confidence for risk of perforation and two specific findings were focal loss of color signal in background increased blood flow of appendix and absence of color signal in the entire appendix. There was no significant association between other characteristics and risk of perforation. Conclusion: Adding color Doppler ultrasonographic exams improved predictability of perforation with increased accuracy and confidence during routine gray-scale ultrasonography of acute appendicitis. 1215 Where is Ultrasonographics Exams for Acute Appendicitis in MDCT Era? - Direct Comparison of Ultrasonography with MDCT in Same Patients Min Yeong Kim, Department of Radiology, Korea University Ansan Hospital, Korea Sang Hoon Cha, Korea University Ansan Hospital, Korea University College of Medicine, Korea Hwan Hoon Chung, Department of Radiology, Korea University Ansan Hospital, Korea Seung Hwa Lee, Korea University Hospital, Korea Bo Kyung Je, Department of Radiology, Korea University Ansan Hospital, Korea Purpose: To directly compare of diagnostic accuracy and confidence of ultrasonography with MDCT for acute appendicitis with/without complication in same patients and to analyze affecting factors to diagnostic performance. Learning Objects: To understand different characteristics between ultrasonography and MDCT for evaluation of appendiceal abnormalities. To analyze the false negative results of MDCT in acute appendicitis despite correct ultrasonographic diagnoses. To evaluate added values of color Doppler exams for diagnosis of acute appendicitis and complication. To help with choosing the first diagnostic modality between ultrasonography and MDCT. To consider surgeons’ views of diagnostic modalities. Conclusion: Though MDCT is accurate and surgeons’ preference, ultrasonographic exam must be considered the first diagnostic modality in patients with acute appendicitis. 1216 Ultrasound Findings of Torn Greater Omentum Van Nghiep Nguyen, MD, Vietnam Vu Quang Duong, MD, Vietnam Hung Thien Nguyen, MD, Vietnam Hai Thanh Phan, MD, Vietnam Purpose: To report 2 rare cases of hemoperitoneum caused by torn greater omentum. Materials and Methods: Abdominal ultrasound first , and then abdominal punction and surgery confirmed. Results: 2 male patients 32-44 y.o were seen with diffuse abdominal pain of 24-48 hours duration. They had no fever, nausea, or