เปรียบเทียบความแม่นยำระหว่างการใช้เอกซเรย์คอมพิวเตอร์ช่องท้องส่วนล่างแบบใช้สารทึบรังสีและไม่ใช้สารทึบรังสี ในการวินิจฉัยภาวะไส้ติ่งอักเสบในผู้ใหญ่ ในโรงพยาบาลอุทัยธานี

Siriwan  Noppakun

Authors

Siriwan Noppakun Uthaithani hospital

Keywords:

Appendicitis, Differential diagnosis of lower abdominal pain, CT lower abdomen, Contrast media

Abstract

Objective: To compare the diagnostic accuracy of Contrast-Enhanced Computed Tomography (CECT) and Non-Contrast Computed Tomography (NECT) of the lower abdomen in diagnosing acute appendicitis and other differential diagnoses in adult patients presenting with lower abdominal pain.

Methods: This retrospective observational cohort study included 265 patients aged ≥ 15 years with suspected appendicitis at Uthai Thani Hospital between January 1, 2024, and December 31, 2024. Both CECT and NECT images of the lower abdomen were reviewed to analyze and compare accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Statistical analysis was performed using the McNemar t-test, with final clinical diagnoses and pathological results serving as the gold standard.

Results: The diagnostic accuracy for acute appendicitis was high and comparable between CECT and NECT at 97.7% and 96.2%, respectively, with no statistically significant difference (p-value = 0.51). Sensitivity, specificity, PPV, and NPV were also similarly high for both modalities. However, for the differential diagnosis causes of lower abdominal pain, CECT demonstrated significantly higher diagnostic accuracy than NECT (p-value < 0.01).

Conclusion: NECT is highly effective and comparable to CECT for diagnosing acute appendicitis, making it a safe and viable alternative for patients with contraindications to intravenous contrast media. Nevertheless, in cases where other differential diagnoses of lower abdominal pain must be identified, CECT remains the superior diagnostic tool for achieving an accurate final diagnosis.

Keywords: Appendicitis, Differential diagnosis of lower abdominal pain, CT lower abdomen, Contrast media

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