BACKGROUND Recent clinical trials in adults and children have shown that uncomplicated acute appendicitis can be successfully treated with antibiotics alone. As treatment strategies for acute appendicitis diverge, accurate preoperative diagnosis of complicated appendicitis and appendiceal perforation has become increasingly important for clinical decision-making. OBJECTIVE To examine diagnostic performance of ultrasound for detecting perforated appendicitis in a single institution using a standardized technique. MATERIALS AND METHODS In this retrospective single-center study we evaluated 113 ultrasounds from pediatric patients who underwent appendectomy between November 2014 and December 2015. All ultrasounds were performed using a standardized US protocol including still and cine images of all four abdominal quadrants, with more targeted evaluation of the right lower quadrant (RLQ) using graded compression technique. We compared US findings to intraoperative diagnosis of non-perforated or perforated acute appendicitis. RESULTS The standardized image protocol generated a reproducible set of ultrasound images in all cases. The most common primary appendiceal finding on US in perforated appendicitis was appendix wall thickening >3 mm (54%, 171/314) and most common secondary finding was echogenic mesenteric fat (75%, 237/314). Thinning of the appendix wall and loculated fluid collection in the right lower quadrant were both highly specific (>90%) for perforation. CONCLUSION The diagnostic performance of ultrasound using a standardized US technique was similar to that reported in prior studies for detecting perforated appendicitis. Despite low sensitivity, individual ultrasound findings and overall diagnostic impression of "evidence of appendix perforation" remain highly specific.

中文翻译：

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标准化超声协议对小儿阑尾炎穿孔的诊断性能。

背景技术最近在成人和儿童中进行的临床试验表明，单纯使用抗生素可以成功治疗简单的急性阑尾炎。随着急性阑尾炎的治疗策略的差异，复杂的阑尾炎和阑尾穿孔的准确术前诊断对于临床决策变得越来越重要。目的探讨使用标准化技术在单个机构中检测超声对穿孔性阑尾炎的诊断性能。材料与方法在这项回顾性单中心研究中，我们评估了2014年11月至2015年12月间接受阑尾切除术的小儿患者的113例超声。所有超声均采用标准化的US方案进行，包括所有四个腹象限的静止图像和电影图像，使用分级压缩技术对右下象限（RLQ）进行更有针对性的评估。我们将美国的发现与术中诊断为非穿孔或穿孔的急性阑尾炎进行了比较。结果标准化图像协议在所有情况下均产生了一组可重现的超声图像。在穿孔性阑尾炎中，最常见的原发性阑尾发现是阑尾壁增厚> 3 mm（54％，171/314），最常见的次要发现是回声性肠系膜脂肪（75％，237/314）。阑尾壁变薄和右下象限中的局部积液对穿孔均具有很高的特异性（> 90％）。结论使用标准化的美国技术对超声的诊断性能与先前研究中发现的穿孔性阑尾炎相似。尽管灵敏度低，