A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain

Adrienne van Randen, Wytze Laméris, 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, OPTIMA Study Group, A van Randen, W Laméris, J Stoker, M A Boermeester, P M M Bossuyt, B van Ramshorst, J P M van Heesewijk, M P Gorzeman, W H Bouma, W ten Hove, J Winkelhagen, H G Gooszen, M S van Leeuwen, D E J G J Dolmans, E van Keulen, J W Juttmann, M J van der Laan, S C Donkervoort, V P M van der Hulst, Adrienne van Randen, Wytze Laméris, 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, OPTIMA Study Group, A van Randen, W Laméris, J Stoker, M A Boermeester, P M M Bossuyt, B van Ramshorst, J P M van Heesewijk, M P Gorzeman, W H Bouma, W ten Hove, J Winkelhagen, H G Gooszen, M S van Leeuwen, D E J G J Dolmans, E van Keulen, J W Juttmann, M J van der Laan, S C Donkervoort, V P M van der Hulst

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.

Figures

Fig. 1
Fig. 1
Comparison of sensitivity and positive predictive value (PPV) for subgroups of observers

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