Imaging for appendicitis: should radiation-induced cancer risks affect modality selection?
Imaging for appendicitis: should radiation-induced cancer risks affect modality selection?
复制标题
阑尾炎影像学：辐射诱发的癌症风险是否会影响治疗方式的选择？
DOI：
10.1148/radiol.14132629
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发表时间：
2014
期刊：
影响因子：
19.7
通讯作者：
Pandharipande,PariV
中科院分区：
文献类型：
--
作者：
Kiatpongsan,Sorapop;Meng,Lesley;Eisenberg,JonathanD;Herring,Maurice;Avery,LauraL;Kong,ChungYin;Pandharipande,PariV
PurposeTo compare life expectancy (LE) losses attributable to three imaging strategies for appendicitis in adults—computed tomography (CT), ultrasonography (US) followed by CT for negative or indeterminate US results, and magnetic resonance (MR) imaging—by using a decision-analytic model.Materials and MethodsIn this model, for each imaging strategy, LE losses for 20-, 40-, and 65-year-old men and women were computed as a function of five key variables: baseline cohort LE, test performance, surgical mortality, risk of death from delayed diagnosis (missed appendicitis), and LE loss attributable to radiation-induced cancer death. Appendicitis prevalence, test performance, mortality rates from surgery and missed appendicitis, and radiation doses from CT were elicited from the published literature and institutional data. LE loss attributable to radiation exposure was projected by using a separate organ-specific model that accounted for anatomic coverage during a typical abdominopelvic CT examination. One- and two-way sensitivity analyses were performed to evaluate effects of model input variability on results.ResultsOutcomes across imaging strategies differed minimally—for example, for 20-year-old men, corresponding LE losses were 5.8 days (MR imaging), 6.8 days (combined US and CT), and 8.2 days (CT). This order was sensitive to differences in test performance but was insensitive to variation in radiation-induced cancer deaths. For example, in the same cohort, MR imaging sensitivity had to be 91% at minimum (if specificity were 100%), and MR imaging specificity had to be 62% at minimum (if sensitivity were 100%) to incur the least LE loss. Conversely, LE loss attributable to radiation exposure would need to decrease by 74-fold for combined US and CT, instead of MR imaging, to incur the least LE loss.ConclusionThe specific imaging strategy used to diagnose appendicitis minimally affects outcomes. Paradigm shifts to MR imaging owing to concerns over radiation should be considered only if MR imaging test performance is very high.© RSNA, 2014
