Diagnostic performance of spectral Doppler in acute appendicitis with an equivocal Alvarado score

PURPOSE

This study aims to evaluate the added value of duplex Doppler examination to the routinely graded compression grayscale ultrasound (US) for patients with suspected acute appendicitis (AA) in correlation with surgical management outcomes.

METHODS

The study lasted from January 2020 to March 2021. Throughout that period, patients who had suspected appendicitis were included with a visible appendix in the grayscale US. These patients were categorized clinically based on Alvarado's score. They underwent graded compression grayscale US of the appendix and duplex Doppler study. Subsequently, they were assigned for non-contrast multislice computed tomography (MSCT) according to Alvarado's score and underwent either emergency appendicectomy or conservative clinical management afterward. A Student's t-test was used to determine if there were significant differences in the mean values between the groups. The diagnostic performance of spectral Doppler US for the diagnosis of AA was depicted.

RESULTS

Eighty-four patients with visualized color flow in the appendicular Doppler US were enrolled, with 60 (71.4%) having AA, and 24 (28.6%) not having appendicitis. Spectral Doppler criterion of PSV greater than 8.6 cm/s demonstrated a high sensitivity of 91.67% and specificity of 77.78% for patients with Alvarado score ranging from 4 to 7, and appendiceal MOD ranging from 6 to 8 mm, while a discriminatory criterion of RI greater than 0.51 had a high sensitivity of 100% and a relatively lower specificity of 66.67%.

CONCLUSION

The patients with AA have significantly higher point PSV and point RI values than those without AA and are especially useful in equivocal patients whose MODs and Alvarado scores are in the diagnostically equivocal ranges of 6-8 mm and 4-7, respectively, with the point PSV and RI demonstrating negative predictive value 87.5% and 100%.

Analysis of outcomes of endovascular embolisation: A cross-sectional two-center study on 46 visceral artery pseudoaneurysms

Purpose

Visceral artery pseudoaneurysms (VAPAs) are uncommon in clinical practice but may have serious clinical outcomes up to death. Endovascular management is a safe effective alternative option to traditional surgical procedures. This study assesses the outcome of different embolic materials and techniques used in the endovascular management of VAPAs.

Materials and methods

This is a two-center retrospective analysis of endovascular embolisation of 46 VAPAs, with a mean pseudoaneurysm size of 13 ± 11.35 mm, that were urgently managed between July 2018 and March 2020. Patients’ presentations were GIT hemorrhage, intrabdominal hemorrhage, hematuria, and abdominal pain in 34.78%, 30.43%, 23.91%, and 10.87% respectively. Management using coils only was done in 28/46 patients (60.87%), NBCA glue only in 16/46 patients (34.78%), combined coils and NBCA glue in 1/46 patient (2.17%), and Amplatzer plugs only in 1 patient (2.17%). The management techniques were sac packing in 9/46 patients (19.57%), inflow occlusion in 28/46 patients (60.87%) and trapping in 9/46 patients (19.57%). All patients were followed-up for 1 year after the procedure.

Results

The overall clinical success and periprocedural complication rates were 93.48%, and 15.22% respectively, and 30-day mortality was zero. Clinical success was 92.86% in the coil subgroup (n = 28), and 93.75% in the NBCA glue subgroup (n = 16). The technical success rate was 100%. Effectiveness of the procedures during the follow-up was 97.83%. Target lesion re-intervention rate was 2.17%.

Conclusion

Transarterial embolisation can provide high technical and clinical success rates with low periprocedural complication and re-intervention rates, as well as satisfactory procedure effectiveness in the management of VAPAs.