Low-Dose Abdominal CT for Evaluating Suspected Appendicitis
Low-Dose Abdominal CT for Evaluating Suspected Appendicitis
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DOI：
10.1056/nejmoa1110734
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发表时间：
2012-04-26
影响因子：
158.5
通讯作者：
Lee, Kyoung Ho
中科院分区：
文献类型：
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作者：
Kim, Kyuseok;Kim, Young Hoon;Lee, Kyoung Ho
背景计算机断层扫描（CT）已成为诊断成人急性阑尾炎的主要检查方法。对于儿童和年轻人来说，接触 CT 辐射尤其值得关注。我们评估了疑似阑尾炎的年轻人在低剂量与标准剂量腹部 CT 后阴性（不必要）阑尾切除术的发生率。方法在这项单机构、单盲、非劣效性试验中，我们将 891 名疑似阑尾炎患者随机分配至低剂量 CT（444 名患者）或标准剂量 CT（447 名患者）。以剂量长度乘积计算的中位辐射剂量在低剂量组中为116 mGy.cm，在标准剂量组中为521 mGy.cm。主要终点是所有非偶然阑尾切除术中阴性阑尾切除术的百分比，非劣效性界限为 5.5 个百分点。次要终点包括阑尾穿孔率和需要额外影像学检查的疑似阑尾炎患者比例。 结果 低剂量 CT 组阑尾切除阴性率为 3.5%（172 例患者中 6 例），标准剂量 CT 组为 3.2%（186 例患者中 6 例）（差异为 0.3 个百分点；95% 置信区间为 -3.8 至 4.6）。两组阑尾穿孔率（低剂量CT为26.5%，标准剂量CT为23.3%，P=0.46）或需要额外影像学检查的患者比例（分别为3.2%和1.6%；P=0.09）没有显着差异。阑尾炎。 （由 GE Healthcare Medical Diagnostics 和其他机构资助；ClinicalTrials.gov 编号，NCT00913380。）
BackgroundComputed tomography (CT) has become the predominant test for diagnosing acute appendicitis in adults. In children and young adults, exposure to CT radiation is of particular concern. We evaluated the rate of negative (unnecessary) appendectomy after low-dose versus standard-dose abdominal CT in young adults with suspected appendicitis.MethodsIn this single-institution, single-blind, noninferiority trial, we randomly assigned 891 patients with suspected appendicitis to either low-dose CT (444 patients) or standard-dose CT (447 patients). The median radiation dose in terms of dose-length product was 116 mGy.cm in the low-dose group and 521 mGy.cm in the standard-dose group. The primary end point was the percentage of negative appendectomies among all nonincidental appendectomies, with a noninferiority margin of 5.5 percentage points. Secondary end points included the appendiceal perforation rate and the proportion of patients with suspected appendicitis who required additional imaging.ResultsThe negative appendectomy rate was 3.5% (6 of 172 patients) in the low-dose CT group and 3.2% (6 of 186 patients) in the standard-dose CT group (difference, 0.3 percentage points; 95% confidence interval, -3.8 to 4.6). The two groups did not differ significantly in terms of the appendiceal perforation rate (26.5% with low-dose CT and 23.3% with standard-dose CT, P=0.46) or the proportion of patients who needed additional imaging tests (3.2% and 1.6%, respectively; P=0.09).ConclusionsLow-dose CT was noninferior to standard-dose CT with respect to negative appendectomy rates in young adults with suspected appendicitis. (Funded by GE Healthcare Medical Diagnostics and others; ClinicalTrials.gov number, NCT00913380.)