Kontrastsız Bilgisayarlı Tomografide Apendiks Görünürlüğü ile Visseral Obezite Arasındaki İlişki: Retrospektif Kesitsel Çalışma

Abstract

ÖZET Amaç: Bu çalışma, yüksek visseral obeziteye sahip hastalarda apendiksin kontrastsız bilgisayarlı tomografide (NCCT) görüntülenebilirliğini değerlendirmeyi ve böylece intravenöz (IV) kontrast madde kullanım gereksinimini azaltmayı amaçlamaktadır. Yöntem: Çalışma popülasyonu, Ocak 2021 ile Ocak 2022 tarihleri arasında üçüncü basamak bir hastanede NCCT görüntülemesi yapılan erişkin hastalardan oluşmaktadır. Veriler elektronik tıbbi kayıtlar ve görüntüleme veritabanlarından elde edilmiş; yaş, cinsiyet, BT bulguları ve visseral yağ alanı (VFA) ölçümlerini içermektedir. Veri analizinde tanımlayıcı istatistikler, ki-kare testi, Spearman rho korelasyon testi ve lojistik regresyon analizi kullanılmıştır. Bulgular: Bu çalışmada 1562 hasta (720 kadın, 842 erkek) değerlendirilmiş ve apendiks görünürlüğü, yaş ve visseral obezite arasındaki ilişki incelenmiştir. Apendiks 1390 hastada (%89) görüntülenebilirken, 172 hastada (%11) işaretlenememiştir. Visseral yağ alanı yüksek olan hastalarda (VFA > 130), apendiks görüntülenme oranının düşük VFA'ya sahip hastalara göre anlamlı derecede daha yüksek olduğu bulunmuştur (p < 0,001). Sonuç: Bulgular, apendiks görünürlüğünün visseral obezitenin radyolojik bir sonucu olarak değerlendirilmesinin önemini ortaya koymaktadır. Yüksek VFA'ya sahip hastalarda NCCT, apendiksin görüntülenmesinde faydalı olabilir ve IV kontrast madde kullanım gereksinimini azaltabilir.

Keywords

• Akut apandisit
• kontrastsız bilgisayarlı tomografi
• abdominal tomografi
• visseral obezite.

Supporting Institution

yok

Ethical Statement

Bu çalışma, Ankara Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (AESH-EK1-2023-225).

Thanks

yok

The Relationship between Appendix Visibility on Non-Contrast Computed Tomography and Visceral Obesity: A Retrospective Cross-Sectional Study

Abstract

Objective: This study aims to evaluate the visibility of the appendix on non-contrast computed tomography (NCCT) in patients with high visceral obesity, thereby reducing the need for intravenous (IV) contrast. 

Methods: The study population consists of adult patients who underwent NCCT imaging at a tertiary hospital between January 2021 and January 2022. The data were collected from electronic medical records and imaging databases, including age, gender, CT findings, and visceral fat area (VFA) measurement. Descriptive statistics, chi-square test, Spearman's rho test, and logistic regression analysis were used for data analysis. 

Results: In this study of 1562 patients (720 female, 842 male), we examined the relationship between appendix visibility, age, and visceral obesity. The appendix was visualized in 1390 patients (89%) and could not be marked in 172 patients (11%). We found that appendix visualization was significantly higher in patients with a high visceral fat area (VFA > 130) compared to those with a low VFA (p < 0.001). 

Conclusions: The results highlight the potential importance of considering appendix visibility as a radiological consequence of visceral obesity. NCCT will be useful for visualizing the appendix in patients with high VFA and may reduce the need for IV contrast.

Keywords

• Acute appendicitis
• non-contrast computed tomography
• abdominal tomography
• visceral obesity

Supporting Institution

none.

Ethical Statement

The Ethics Committee of of clinical research of Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital approved the present study (AESH-EK1-2023-225).

Thanks

none

References

1. References 1. Addiss DG, Shaffer N, Fowler BS et al. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990 Nov;132(5):910-25.
2. 2. Bhangu A, Søreide K, Di Saverio S et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015 Sep 26;386(10000):1278-87.
3. 3. Guldogan CE, Sarp G, Soyer Guldogan E. Comparison of Hem-o-lok and Endoloop for Appendiceal Stump Closure in Laparoscopic Appendectomy: An Observational Retrospective Study. Ann Ital Chir. 2024 Feb. 20 [cited 2024 Mar. 30];95(1):105-8.
4. 4. Zacharzewska-Gondek A, Szczurowska A, Guziński M et al. A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications. Pol J Radiol. 2019 Jan 4;84:e1-e8.
5. 5. Garcia EM, Camacho MA, Karolyi DR et al. ACR Appropriateness Criteria® right lower quadrant pain-suspected appendicitis. Journal of the American College of Radiology, 15(11), S373-S387.
6. 6. Pinto Leite N, Pereira JM, Cunha R et al. CT evaluation of appendicitis and its complications: imaging techniques and key diagnostic findings. AJR Am J Roentgenol. 2005 Aug;185(2):406-17.
7. 7. Sauvain MO, Tschirky S, Patak MA et al. Acute appendicitis in overweight patients: the role of preoperative imaging. Patient Saf Surg. 2016 May 17;10:13.
8. 8. Quadri R, Vasan V, Hester C et al. Comprehensive review of typical and atypical pathology of the appendix on CT: cases with clinical implications. Clinical Imaging. 2019 Jan 1;53:65-77.

9. 9. Canter LM. Anaphylactoid Reactions to Radiocontrast Media. Allergy and Asthma Prc. 2005 May: 26:3:199–203.
10. 10. Lieberman P, Nicklas RA, Oppenheimer J et al. The diagnosis and management of anaphylaxis: an updated practice parameter. Journal of Allergy and Clinical Immunology. 2005 Mar 1;115(3):S483-523.
11. 11. Davenport MS, Perazella MA, Yee J et al. Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology. 2020 Mar;294(3):660-8.
12. 12. Su TH, Hsieh CH, Chan YL et al. Intravenous CT contrast media and acute kidney injury: a multicenter emergency department–based study. Radiology. 2021 Dec;301(3):571-81.
13. 13. Keyzer C, Pargov S, Tack D et al. Normal appendix in adults: reproducibility of detection with unenhanced and contrast-enhanced MDCT. American journal of roentgenology. 2008 Aug;191(2):507-14.
14. 14. IDF Epidemiology Task Force Consensus Group. (2005). International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome. http://www.idf.org/webdata/docs/Metabolic_syndrome_def. pdf.
15. 15. National Institutes of Health. (2015). National Heart, Lung and Blood Institute. Clinical Guidelines on the Identification, Evaluation and Treatment of Overweight and Obesity in Adults. The Evidence Report. United States, 1998. Online (accessed May 13, 2010): http://www. nhlbi. nih. gov/guidelines/obesity/prctgd_c. pdf.
16. 16. Moris D, Paulson EK, Pappas TN. Diagnosis and Management of Acute Appendicitis in Adults: A Review. JAMA. 2021;326(22):2299–2311.
17. 17. Xiong B, Zhong B, Li Z et al. Diagnostic accuracy of noncontrast CT in detecting acute appendicitis: a meta-analysis of prospective studies. The American Surgeon, 2015; 81(6), 626-629.
18. 18. Rao PM, Rhea JT, Novelline RA et al. Helical CT technique for the diagnosis of appendicitis: prospective evaluation of a focused appendix CT examination. Radiology 1997; 202:139-144.
19. 19. Anderson SW, Soto JA, Lucey BC et al. Abdominal 64-MDCT for Suspected Appendicitis: The Use of Oral and IV Contrast Material Versus IV Contrast Material Only. AJR Am J Roentgenol. 2009;193(5):1282-8.
20. 20. Ozturkmen Akay H, Akpinar E, Akgul Ozmen C et al. Visualization of the normal appendix in children by non-contrast MDCT. Acta chirurgica Belgica, 2007;107(5), 531-534.
21. 21. Kvist H, Chowdhury B, Grangard U et al. Total and visceral adipose-tissue volumes derived from measurements with computed tomography in adult men and women: predictive equations. Am J Clin Nutr 1988;48:1351–61.
22. 22. Gaitini D, Beck-Razi N, Mor-Yosef D et al. Diagnosing acute appendicitis in adults: accuracy of color Doppler sonography and MDCT compared with surgery and clinical follow-up. Am J Roentgenol. 2008;190:1300–6.