Quantitative Measurement of Elasticity of the Appendix Using Shear Wave Elastography in Patients with Suspected Acute AppendicitisReport as inadecuate

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Shear wave elastography SWE has not been studied for diagnosing appendicitis. We postulated that an inflamed appendix would become stiffer than a normal appendix. We evaluated the elastic modulus values EMV by SWE in healthy volunteers, patients without appendicitis, and patients with appendicitis. We also evaluated diagnostic ability of SWE for differentiating an inflamed from a normal appendix in patients with suspected appendicitis.

Materials and Methods

Forty-one patients with clinically suspected acute appendicitis and 11 healthy volunteers were prospectively enrolled. Gray-scale ultrasonography US, SWE and multi-slice computed tomography CT were performed. The EMV was measured in the anterior, medial, and posterior appendiceal wall using SWE, and the highest value kPa was recorded.


Patients were classified into appendicitis n = 30 and no appendicitis groups n = 11. One case of a negative appendectomy was detected. The median EMV was significantly higher in the appendicitis group 25.0 kPa compared to that in the no appendicitis group 10.4 kPa or in the healthy controls 8.3 kPa p<0.001. Among SWE and other US and CT features, CT was superior to any conventional gray-scale US feature or SWE. Either the CT diameter criterion or combined three CT features predicted true positive in 30 and true negative in 11 cases and yielded 100% sensitivity and 100% specificity. An EMV of 12.5 kPa for the stiffest region of the appendix predicted true positive in 28, true negative in 11, and false negative in two cases. The EMV ≥12.5 kPa yielded 93% sensitivity and 100% specificity.


Our results suggest that EMV by SWE helps distinguish an inflamed from a normal appendix. Given that SWE has high specificity, quantitative measurement of the elasticity of the appendix may provide complementary information, in addition to morphologic features on gray-scale US, in the diagnosis of appendicitis.

Author: Seung-Whan Cha, Ik Yong Kim, Young Wan Kim

Source: http://plos.srce.hr/


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