Top

Japanese Journal of Radiology

Published in:

Open Access 01-02-2020 | Appendicitis | Original Article

Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study

Authors: Bimbadhar Valluru, Zhou Zhou, Dineswar Sah, Wei Du, Mahamed O. Ali, Ahmed A. Adam, Liang Zhang, Juan J. Wang

Published in: Japanese Journal of Radiology | Issue 2/2020

Abstract

Purpose

To clarify unique non-contrast CT (NCCT) characteristics for early recognition of Schistosomal associated appendicitis (SAA) differentiating from Non-schistosomal associated appendicitis (NSA).

Material and methods

Clinical and pathological data of 50 cases with SAA and 60 cases with NSA who underwent emergency appendectomy were retrospectively compared to pre-surgical NCCT features such as direct and indirect signs of acute appendicitis as well as appendicoliths, colon calcifications as diagnostic criteria. Statistical methods such as Chi-square (χ²), t-tests, Principal component analysis (PCA), Binary Logistic regression (LR) and Factor Analysis (FA) were utilized to observe differences and isolate recognizable CT features of SAA. Pre and post hoc diagnostic performance of all criteria was calculated as sensitivity, specificity, and the Odds Ratio (OR).

Results

Age > 50 years, diameter > 13 mm, pneumatosis, peri appendiceal abscess, focal wall defect, perforation; Orbital, linear and point types of appendicular wall calcifications; sigmoid colon and cecal curvilinear calcifications were observed as unique characteristics with a sensitivity of 84–95% and specificity of 91–98% in predicting SAA by OR of 6.2 times. Pre and post hoc hypothetical analysis did not show any significance for all other factors.

Conclusion

Factors such as elderly age, CT features such as larger appendicular diameter, appendicular wall calcifications along with sigmoid colon, and cecal calcifications, signs of perforation or abscess are characteristic for early recognition of SAA.

Elbaz T, Esmat G. Hepatic and intestinal schistosomiasis: review. J Adv Res. 2013;4(5):445–52. https://doi.org/10.1016/j.jare.2012.12.001.CrossRefPubMedPubMedCentral

Chitsulo L, Loverde P, Engels D. Disease Watch/Focus: Schistosomiasis. Nat Rev Microbiol. 2004;2(1):12–3. https://doi.org/10.1038/nrmicro801.CrossRefPubMed

Araujo Navas AL, Soares Magalhães RJ, Osei F, Fornillos RJC, Leonardo LR, Stein A. Modelling local areas of exposure to Schistosoma japonicum in a limited survey data environment. Parasites & vectors. 2018;11(1):1–15. https://doi.org/10.1186/s13071-018-3039-6.CrossRef

Qian C, Zhang Y, Zhang X, Yuan C, Gao Z, Yuan H, et al. Effectiveness of the new integrated strategy to control the transmission of Schistosoma japonicum in China: a systematic review and meta-analysis. Parasite. 2018;25:54. https://doi.org/10.1051/parasite/2018058.CrossRefPubMedPubMedCentral

Yang Y, Zheng SB, Yang Y, Cheng WT, Pan X, Dai QQ, et al. The three gorges dam: does the flooding time determine the distribution of schistosome-transmitting snails in the middle and Lower reaches of the Yangtze River, China? Int J Environ Res Public Health. 2018;15(7):1304. https://doi.org/10.3390/ijerph15071304.CrossRefPubMedCentral

Wang XY, Xu J, Zhao S. Estimating the prevalence of schistosomiasis japonica in China: a serological approach. Infect Dis Poverty. 2018;7(1):62. https://doi.org/10.1186/s40249-018-0443-2.CrossRefPubMedPubMedCentral

Luo TP, Zhou XN, Qiu ZL. Cost-effectiveness and cost benefit of integrated schistosomiasis control strategy with emphasis on infectious source control in mountainous areas of Yunnan Province. Chinese J Schistosomiasis Control. 2009;21:93–7.

Anderson BA, Salem L, Flum DR. A systematic review of whether oral contrast is necessary for the computed tomography diagnosis of appendicitis in adults. Am J Surg. 2005;190(3):474–8. https://doi.org/10.1016/j.amjsurg.2005.03.037.CrossRefPubMed

Dillman JR, Gadepalli S, Sroufe NS, Davenport MS, Smith EA, Chong ST. Equivocal pediatric appendicitis: unenhanced MR imaging protocol for nonsedated children-a clinical effectiveness study. Radiology. 2015;15:0941. https://doi.org/10.1148/radiol.2015150941.CrossRef

10.

Xiong B, Zhong B, Li Z, Zhou F, Hu R, Feng Z, et al. Diagnostic accuracy of noncontrast CT in detecting acute appendicitis: a meta-analysis of prospective studies. Am Surg. 2015;81(6):626–9.PubMed

11.

Eltawil KM, Plassmann M. Theodor maximillian bilharz (1825–1862): the discoverer of schistosomiasis. Int J Parasitol Res. 2011;3(1):17–25. https://doi.org/10.9735/0975-3702.3.1.17-25.CrossRef

12.

Botes SN, Ibirogba SB, McCallum AD, Kahn D. Schistosoma prevalence in appendicitis. World J Surg. 2015;39:1080–3. https://doi.org/10.1007/s00268-015-2954-3.CrossRefPubMed

13.

Pooler BD, Lawrence EM, Pickhardt PJ. MDCT for suspected appendicitis in the elderly: diagnostic performance and patient outcome. Emerg Radiol. 2012;19(1):27–33. https://doi.org/10.1007/s10140-011-1002-3.CrossRefPubMed

14.

Lane MJ, Liu DM, Huynh MD, Jeffrey RB, Mindelzun RE, Katz DS. Suspected acute appendicitis: none enhanced helical CT in 300 consecutive patients. Radiology. 1999;213(2):341–6. https://doi.org/10.1148/radiology.213.2.r99nv44341.CrossRefPubMed

15.

Yumin Z, Weifeng G, Joseph WM, Zhisheng D, Wei H. Advances in diagnosis of schistosomiasis. Microbiol Curr Res. 2018;2(2):14–9. https://doi.org/10.4066/2591-8036.18-404.CrossRef

16.

Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. The Lancet. 2015;386(10000):1278–87. https://doi.org/10.1016/s0140-6736(15)00275-5.CrossRef

17.

de Castro SM, Ünlü C, Steller EP, van Wagensveld BA, Vrouenraets BC. Evaluation of the appendicitis inflammatory response score for patients with acute appendicitis. World J Surg 2012;36(7):1540–45. Erratum in: World J Surg. 2012;36(9):2271 10.1007/s00268–012–1521–4

18.

Dr Anil Kumar Saha, Dr Tushar Kanti Chatterjee, Dr Sartaj Sohail, Dr Neel Saha. Evaluation of the Appendicitis Inflammatory Response Score for Patients with suspected Acute Appendicitis. IOSR J Dent Med Sci. 2018;17 (2): 40–44 10.9790/0853-1702024044.

19.

Nelwan ML. Schistosomiasis: life cycle, diagnosis, and control. Curr Ther Res Clin Exp. 2019;91:5–9. https://doi.org/10.1016/j.curtheres.2019.06.001.CrossRefPubMedPubMedCentral

20.

Al-Faouri AF, Ajarma KY, Al-Abbadi AM, Al-Omari AH, Almunaizel TS, Alzu'bi AA, et al. The Alvarado score versus computed tomography in the diagnosis of acute appendicitis: A prospective study. Med J Armed Forces India. 2016;72(4):332–7. https://doi.org/10.1016/j.mjafi.2016.06.007.CrossRefPubMedPubMedCentral

21.

Machado-Silva JR, Neves RH, Gomes DC. Schistosoma mansoni species first described by Piraja da silva in Brazil (1908) reexamined by confocal laser scanning microscopy. Rev Soc Bras Med Trop. 2011;44(3):331–3. https://doi.org/10.1590/s0037-86822011005000027.CrossRefPubMed

22.

Carvalho EM, Lima AAM. Schistosomiasis (bilharziasis). In: Goldman L, Ausiello D, editors. Cecil Medicine. 23rd ed. Philadelphia: Saunders Elsevier-Health Sciences Division; 2007. ch. 376 (ISBN:9781416028055)CrossRef

23.

Cheever AW, Duvall RH, Minker RG. Quantitative parasitologic findings in rabbits infected with Japanese and Philippine strains of Schistosoma japonicum. Am J Trop Med Hyg. 1980;29:1307–75. https://doi.org/10.4269/ajtmh.1980.29.1307.CrossRefPubMed

24.

Ross AG, Bartley PB, Sleigh AC, Olds R, Li Y, Williams GM, et al. Schistosomiasis. N Engl J Med. 2002;346:1212–20. https://doi.org/10.1056/NEJMra012396.CrossRefPubMed

25.

Zhang W, Wang PJ, Shen X, Wang G, Zhao X, Seema SF, et al. CT presentations of colorectal cancer with chronic schistosomiasis: A comparative study with pathological findings. Eur J Radiol. 2012;81(8):e835–e843843. https://doi.org/10.1016/j.ejrad.2012.02.020.CrossRefPubMed

26.

Gore RM, Balthazar EJ, Ghahremani GG, Miller FH. CT features of ulcerative colitis and Crohn's disease. AJR Am J Roentgenol. 1996;167(1):3–15. https://doi.org/10.2214/ajr.167.1.8659415.CrossRefPubMed

27.

Pulimood AB, Amarapurkar DN, Ghoshal U, Phillip M, Pai CG, Reddy DN, Nagi B, Ramakrishna BS. Differentiation of Crohn's disease from intestinal tuberculosis in India in 2010. World J Gastroenterol. 2011;17(4):433–43. https://doi.org/10.3748/wjg.v17.i4.433.CrossRefPubMedPubMedCentral

28.

Manoj MK. Appendicitis-Role of MRI. Pediatr Emer Care. 2019;35:63–8. https://doi.org/10.1097/PEC.0000000000001710.CrossRef

29.

Kim HC, Yang DM, Lee CM, Jin W, Nam DH, Song JY, et al. Acute appendicitis: relationships between CT-determined severities and serum white blood cell counts and C-reactive protein levels. Br J Radiol. 2011;84(1008):1115–20. https://doi.org/10.1259/bjr/47699219.CrossRefPubMedPubMedCentral

30.

Nandipati KC, Parithivel V, Niazi M. Schistosomiasis: a rare cause of acute appendicitis in the African American population in the United States. Am Surg. 2008;74(3):221–3.PubMed

31.

Terada T. Schistosomal appendicitis: incidence in Japan and a case report. World J Gastroenterol. 2009;15:1648–9. https://doi.org/10.3748/wjg.15.1648.CrossRefPubMedPubMedCentral

32.

Avanesov M, Wiese NJ, Karul M, Guerreiro H, Keller S, Busch P, et al. Diagnostic prediction of complicated appendicitis by combined clinical and radiological appendicitis severity index (APSI). Eur Radiol. 2018;28(9):3601–10. https://doi.org/10.1007/s00330-018-5339-9.CrossRefPubMed

33.

Badmos KB, Komolafe AO, Rotimi O. Schistosomiasis presenting as acute appendicitis. East Afr Med J. 2006;83(10):528–32. https://doi.org/10.4314/eamj.v83i10.9464.CrossRefPubMed

34.

Jun Li, Wen S. Clinical analysis of 825 Cases of schistosomiasis appendicitis. Chinese J Surg. 2008;23(4):305.

35.

Hanson KA, Jacob D, Saleh AA, Dissanaike S. In-hospital perforation risk in acute appendicitis: Age matters. 2019. Am J Surg. doi: 10.1016/j.amjsurg.2019.05.015CrossRef

36.

Sah VK, Wang L, Min X, Rizal R, Feng Z, Ke Z, et al. Human schistosomiasis: A diagnostic imaging focused review of a neglected disease. Radiol Infect Dis. 2015;2(3):150–7. https://doi.org/10.1016/j.jrid.2015.11.007.CrossRef

37.

Nepal P, Ojili V, Songmen S, Batchala P, Kumar D, Nagar AM. Multisystem imaging review of human schistosomiasis: characteristic imaging findings. Clin Imaging. 2019;54:163–71. https://doi.org/10.1016/j.clinimag.2019.01.011.CrossRefPubMed

38.

Xiao ZL, Xu KS, Song YH. Unusual cause of lesions in the descending duodenum and liver: A case report and review of literature. World J Clin Cases. 2018;6(11):472–6. https://doi.org/10.12998/wjcc.v6.i11.472.CrossRefPubMedPubMedCentral

39.

Feng H, Lu AG, Zhao XW, Han DP, Zhao JK, Shi L, et al. Comparison of non-schistosomal rectosigmoid cancer and schistosomal rectosigmoid cancer. World J Gastroenterol. 2015;21(23):7225–322. https://doi.org/10.3748/wjg.v21.i23.7225.CrossRefPubMedPubMedCentral

Title: Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study
Authors: Bimbadhar Valluru
Zhou Zhou
Dineswar Sah
Wei Du
Mahamed O. Ali
Ahmed A. Adam
Liang Zhang
Juan J. Wang
Publication date: 01-02-2020
Publisher: Springer Japan
Keywords: Appendicitis
Appendicitis
Schistosomiasis
Published in: Japanese Journal of Radiology / Issue 2/2020
Print ISSN: 1867-1071
Electronic ISSN: 1867-108X
DOI: https://doi.org/10.1007/s11604-019-00905-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Analysis of CT characteristics in the diagnosis of Schistosoma japonicum associated appendicitis with clinical and pathological correlation: a diagnostic accuracy study

Abstract

Purpose

Material and methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Material and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 2/2020

Early volume reduction of the hippocampus after whole-brain radiation therapy: an automated brain structure segmentation study

Dual-energy computed tomography for evaluation of breast cancer: value of virtual monoenergetic images reconstructed with a noise-reduced monoenergetic reconstruction algorithm

Characteristics of cerebral perfusion and diffusion associated with crossed cerebellar diaschisis after acute ischemic stroke

Motion and solution in hepatobiliary agent-enhanced dynamic MRI: solid evidence and unanswered question

Relationship between the degree of abdominal wall movement and the image quality of contrast-enhanced MRI: semi-quantitative study especially focused on the occurrence of transient severe motion artifact

Machine learning-based quantitative texture analysis of conventional MRI combined with ADC maps for assessment of IDH1 mutation in high-grade gliomas