A Comparison of the Accuracy of Ultrasound and Computed Tomography in Common Diagnoses Causing Acute Abdominal Pain

Overview

Journal Eur Radiol

Specialty Radiology

Date 2011 Mar 3

PMID 21365197

Citations 72

Authors

Adrienne van Randen

Wytze Lameris

H Wouter van Es

Hans P M van Heesewijk

Bert van Ramshorst

Wim ten Hove

Willem H Bouma

Maarten S van Leeuwen

Esteban M van Keulen

Patrick M Bossuyt

Jaap Stoker

Marja A Boermeester

Affiliations

Soon will be listed here.

Abstract

Objectives: Head-to-head comparison of ultrasound and CT accuracy in common diagnoses causing acute abdominal pain.

Materials And Methods: Consecutive patients with abdominal pain for >2 h and <5 days referred for imaging underwent both US and CT by different radiologists/radiological residents. An expert panel assigned a final diagnosis. Ultrasound and CT sensitivity and predictive values were calculated for frequent final diagnoses. Effect of patient characteristics and observer experience on ultrasound sensitivity was studied.

Results: Frequent final diagnoses in the 1,021 patients (mean age 47; 55% female) were appendicitis (284; 28%), diverticulitis (118; 12%) and cholecystitis (52; 5%). The sensitivity of CT in detecting appendicitis and diverticulitis was significantly higher than that of ultrasound: 94% versus 76% (p < 0.01) and 81% versus 61% (p = 0.048), respectively. For cholecystitis, the sensitivity of both was 73% (p = 1.00). Positive predictive values did not differ significantly between ultrasound and CT for these conditions. Ultrasound sensitivity in detecting appendicitis and diverticulitis was not significantly negatively affected by patient characteristics or reader experience.

Conclusion: CT misses fewer cases than ultrasound, but both ultrasound and CT can reliably detect common diagnoses causing acute abdominal pain. Ultrasound sensitivity was largely not influenced by patient characteristics and reader experience.

Citing Articles

Nonsurgical Treatment of Splenic Abscesses in Patient With Simultaneous Diagnosis of Endocarditis and Crohn's Disease: A Case Report and Literature Review.

Shabani S Clin Case Rep. 2025; 13(2):e70161.

PMID: 39876927 PMC: 11772213. DOI: 10.1002/ccr3.70161.

Evaluating the Diagnostic Efficacy of Computed Tomography in Appendicitis Cases With Negative Ultrasound Findings.

Vijayakumar V, T P, Sudarsan S S, Kumar T L Cureus. 2024; 16(9):e69822.

PMID: 39435222 PMC: 11492978. DOI: 10.7759/cureus.69822.

Investigating the causes and pattern of peritoneal involvement in CT scan and comparison with ultrasound findings in peritoneal conditions: A two-center, cross-sectional study.

Khoroushi F, Jarahi L, Hassannejad E, Kazemirad N Health Sci Rep. 2024; 7(9):e70026.

PMID: 39210995 PMC: 11358217. DOI: 10.1002/hsr2.70026.

A Novel Deep Learning Approach for the Automatic Diagnosis of Acute Appendicitis.

Dogan K, Selcuk T J Clin Med. 2024; 13(16).

PMID: 39201090 PMC: 11355690. DOI: 10.3390/jcm13164949.

Computed tomography versus ultrasound for the diagnosis of acute cholecystitis: a systematic review and meta-analysis.

Strieder de Oliveira G, Torri G, Gandolfi F, Basso Dias A, Tse J, Francisco M Eur Radiol. 2024; 34(11):6967-6979.

PMID: 38758253 DOI: 10.1007/s00330-024-10783-8.

References

Lazarus D, Slywotsky C, Bennett G, Megibow A, Macari M . Frequency and relevance of the "small-bowel feces" sign on CT in patients with small-bowel obstruction. AJR Am J Roentgenol. 2004; 183(5):1361-6. DOI: 10.2214/ajr.183.5.1831361. View

Stoker J . Magnetic resonance imaging and the acute abdomen. Br J Surg. 2008; 95(10):1193-4. DOI: 10.1002/bjs.6378. View

Potter A, Chandrasekhar C . US and CT evaluation of acute pelvic pain of gynecologic origin in nonpregnant premenopausal patients. Radiographics. 2008; 28(6):1645-59. DOI: 10.1148/rg.286085504. View

Terasawa T, Blackmore C, Bent S, Kohlwes R . Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 2004; 141(7):537-46. DOI: 10.7326/0003-4819-141-7-200410050-00011. View

Shuman W, Ralls P, Balfe D, Bree R, DiSantis D, Glick S . Imaging evaluation of patients with acute abdominal pain and fever. American College of Radiology. ACR Appropriateness Criteria. Radiology. 2000; 215 Suppl:209-12. View

Sheedy S, Earnest 4th F, Fletcher J, Fidler J, Hoskin T . CT of small-bowel ischemia associated with obstruction in emergency department patients: diagnostic performance evaluation. Radiology. 2006; 241(3):729-36. DOI: 10.1148/radiol.2413050965. View

Lameris W, van Randen A, van Es H, van Heesewijk J, van Ramshorst B, Bouma W . Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ. 2009; 338:b2431. PMC: 3273785. DOI: 10.1136/bmj.b2431. View

Lameris W, van Randen A, Bipat S, Bossuyt P, Boermeester M, Stoker J . Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008; 18(11):2498-511. DOI: 10.1007/s00330-008-1018-6. View

Hainaux B, Agneessens E, Bertinotti R, De Maertelaer V, Rubesova E, Capelluto E . Accuracy of MDCT in predicting site of gastrointestinal tract perforation. AJR Am J Roentgenol. 2006; 187(5):1179-83. DOI: 10.2214/AJR.05.1179. View

10.

Gaitini D, Beck-Razi N, Mor-Yosef D, Fischer D, Ben Itzhak O, Krausz M . Diagnosing acute appendicitis in adults: accuracy of color Doppler sonography and MDCT compared with surgery and clinical follow-up. AJR Am J Roentgenol. 2008; 190(5):1300-6. DOI: 10.2214/AJR.07.2955. View

11.

Hertzberg B, Kliewer M, Bowie J, Carroll B, DeLong D, Gray L . Physician training requirements in sonography: how many cases are needed for competence?. AJR Am J Roentgenol. 2000; 174(5):1221-7. DOI: 10.2214/ajr.174.5.1741221. View

12.

Rutjes A, Reitsma J, Coomarasamy A, Khan K, Bossuyt P . Evaluation of diagnostic tests when there is no gold standard. A review of methods. Health Technol Assess. 2007; 11(50):iii, ix-51. DOI: 10.3310/hta11500. View

13.

Puylaert J, Rutgers P, Lalisang R, de Vries B, van der Werf S, Dorr J . A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med. 1987; 317(11):666-9. DOI: 10.1056/NEJM198709103171103. View

14.

. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP. 2007; 37(2-4):1-332. DOI: 10.1016/j.icrp.2007.10.003. View

15.

Silva A, Pimenta M, Guimaraes L . Small bowel obstruction: what to look for. Radiographics. 2009; 29(2):423-39. DOI: 10.1148/rg.292085514. View

16.

Leeflang M, Moons K, Reitsma J, Zwinderman A . Bias in sensitivity and specificity caused by data-driven selection of optimal cutoff values: mechanisms, magnitude, and solutions. Clin Chem. 2008; 54(4):729-37. DOI: 10.1373/clinchem.2007.096032. View

17.

van Randen A, Lameris W, Nio C, Spijkerboer A, Meier M, Tutein Nolthenius C . Inter-observer agreement for abdominal CT in unselected patients with acute abdominal pain. Eur Radiol. 2009; 19(6):1394-407. DOI: 10.1007/s00330-009-1294-9. View

18.

Maglinte D, Howard T, Lillemoe K, Sandrasegaran K, Rex D . Small-bowel obstruction: state-of-the-art imaging and its role in clinical management. Clin Gastroenterol Hepatol. 2008; 6(2):130-9. DOI: 10.1016/j.cgh.2007.11.025. View

19.

Schmutz G, Benko A, Fournier L, Peron J, Morel E, Chiche L . Small bowel obstruction: role and contribution of sonography. Eur Radiol. 1997; 7(7):1054-8. DOI: 10.1007/s003300050251. View

20.

Stoker J, van Randen A, Lameris W, Boermeester M . Imaging patients with acute abdominal pain. Radiology. 2009; 253(1):31-46. DOI: 10.1148/radiol.2531090302. View