Novel Ultrasonographic Evaluation of Microvascular Blood Flow for Non-Operative Management of Uncomplicated Acute Appendicitis in Children

IF 2.1 4区医学 Q2 ACOUSTICS

Journal of Ultrasound in Medicine Pub Date : 2024-08-23 DOI:10.1002/jum.16557

Seitaro Kosaka MD, PhD, Miki Toma MD, Nobuyoshi Asai BS, Toshihiro Yanai MD, PhD

{"title":"Novel Ultrasonographic Evaluation of Microvascular Blood Flow for Non-Operative Management of Uncomplicated Acute Appendicitis in Children","authors":"Seitaro Kosaka MD, PhD, Miki Toma MD, Nobuyoshi Asai BS, Toshihiro Yanai MD, PhD","doi":"10.1002/jum.16557","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Objectives</h3>\n \n <p>To determine whether superb microvascular imaging (SMI) provides a more precise delineation between reversible and irreversible stages of uncomplicated acute appendicitis managed non-operatively.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This prospective clinical study examined pediatric patients with acute appendicitis initially treated non-operatively and evaluated using power Doppler (PD) and SMI. We determined case severity, monitor appendiceal blood flow (BF), and appendicitis reversibility. Complicated cases were excluded. Severity was classified using B-mode as well as PD, or SMI: Grade I, smooth wall/normal BF; Grade IIa, irregular wall/increased BF; Grade IIb, irregular wall/decreased BF; and Grade III, absence of wall/loss of BF.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>This study examined a total of 100 patients with acute appendicitis, after excluding 29 patients. All 10 patients with normal BF on PD (Grade I) showed similar BF on SMI (Grade I). Among 29 patients with increased BF on PD (Grade IIa), corresponding increased BF was noted on SMI (Grade IIa), and all these patients showed full recovery. Of the 55 patients showing decreased BF on PD (Grade IIb), 52 showed increased BF on SMI (Grade IIa). The remaining three patients, identified with an impacted appendicolith, showed decreased BF on SMI (Grade IIb) and experienced treatment failure, subsequently developing abscesses. In all six patients with undetectable BF on PD (Grade III), SMI similarly could not detect appendiceal BF (Grade III), and non-operative management failed for these patients.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>SMI offers an objective and effective means of delineating the threshold between reversible and irreversible stages in uncomplicated acute appendicitis following non-operative management.</p>\n </section>\n </div>","PeriodicalId":17563,"journal":{"name":"Journal of Ultrasound in Medicine","volume":"43 12","pages":"2259-2268"},"PeriodicalIF":2.1000,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Ultrasound in Medicine","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jum.16557","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ACOUSTICS","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives

To determine whether superb microvascular imaging (SMI) provides a more precise delineation between reversible and irreversible stages of uncomplicated acute appendicitis managed non-operatively.

Methods

This prospective clinical study examined pediatric patients with acute appendicitis initially treated non-operatively and evaluated using power Doppler (PD) and SMI. We determined case severity, monitor appendiceal blood flow (BF), and appendicitis reversibility. Complicated cases were excluded. Severity was classified using B-mode as well as PD, or SMI: Grade I, smooth wall/normal BF; Grade IIa, irregular wall/increased BF; Grade IIb, irregular wall/decreased BF; and Grade III, absence of wall/loss of BF.

Results

This study examined a total of 100 patients with acute appendicitis, after excluding 29 patients. All 10 patients with normal BF on PD (Grade I) showed similar BF on SMI (Grade I). Among 29 patients with increased BF on PD (Grade IIa), corresponding increased BF was noted on SMI (Grade IIa), and all these patients showed full recovery. Of the 55 patients showing decreased BF on PD (Grade IIb), 52 showed increased BF on SMI (Grade IIa). The remaining three patients, identified with an impacted appendicolith, showed decreased BF on SMI (Grade IIb) and experienced treatment failure, subsequently developing abscesses. In all six patients with undetectable BF on PD (Grade III), SMI similarly could not detect appendiceal BF (Grade III), and non-operative management failed for these patients.

Conclusions

SMI offers an objective and effective means of delineating the threshold between reversible and irreversible stages in uncomplicated acute appendicitis following non-operative management.

查看原文本刊更多论文

新型微血管血流超声评估用于非手术治疗儿童非并发急性阑尾炎：前瞻性临床研究

目的确定超微血管成像（SMI）是否能更精确地划分非手术治疗的无并发症急性阑尾炎的可逆和不可逆阶段：这项前瞻性临床研究对最初接受非手术治疗的急性阑尾炎儿科患者进行了检查，并使用动力多普勒（PD）和 SMI 进行了评估。我们确定了病例的严重程度，监测了阑尾血流（BF）和阑尾炎的可逆性。并发症病例被排除在外。严重程度通过 B 型、PD 或 SMI 进行分类：I 级，壁光滑/血流正常；IIa 级，壁不规则/血流增加；IIb 级，壁不规则/血流减少；III 级，无壁/血流丧失：本研究共检查了 100 名急性阑尾炎患者，排除了 29 名患者。在 PD（I 级）上 BF 正常的 10 位患者在 SMI（I 级）上均显示出相似的 BF。在 29 名急性阑尾炎 BF 增高（IIa 级）的患者中，SMI（IIa 级）也有相应的 BF 增高，这些患者均完全康复。55 名患者的血压在胸片上下降（IIb 级），52 名患者的血压在 SMI 上上升（IIa 级）。其余 3 名患者被确认为阑尾结石撞击，在 SMI 上显示 BF 下降（IIb 级），治疗失败，随后出现脓肿。在 PD 检测不到 BF（III 级）的所有六名患者中，SMI 同样也检测不到阑尾 BF（III 级），这些患者的非手术治疗均告失败：结论：SMI 是一种客观有效的方法，可在非手术治疗后确定无并发症急性阑尾炎可逆和不可逆阶段的界限。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Ultrasound in Medicine 医学-核医学

CiteScore

5.10

自引率

4.30%

发文量

205

审稿时长

1.5 months

期刊介绍： The Journal of Ultrasound in Medicine (JUM) is dedicated to the rapid, accurate publication of original articles dealing with all aspects of medical ultrasound, particularly its direct application to patient care but also relevant basic science, advances in instrumentation, and biological effects. The journal is an official publication of the American Institute of Ultrasound in Medicine and publishes articles in a variety of categories, including Original Research papers, Review Articles, Pictorial Essays, Technical Innovations, Case Series, Letters to the Editor, and more, from an international bevy of countries in a continual effort to showcase and promote advances in the ultrasound community. Represented through these efforts are a wide variety of disciplines of ultrasound, including, but not limited to: -Basic Science- Breast Ultrasound- Contrast-Enhanced Ultrasound- Dermatology- Echocardiography- Elastography- Emergency Medicine- Fetal Echocardiography- Gastrointestinal Ultrasound- General and Abdominal Ultrasound- Genitourinary Ultrasound- Gynecologic Ultrasound- Head and Neck Ultrasound- High Frequency Clinical and Preclinical Imaging- Interventional-Intraoperative Ultrasound- Musculoskeletal Ultrasound- Neurosonology- Obstetric Ultrasound- Ophthalmologic Ultrasound- Pediatric Ultrasound- Point-of-Care Ultrasound- Public Policy- Superficial Structures- Therapeutic Ultrasound- Ultrasound Education- Ultrasound in Global Health- Urologic Ultrasound- Vascular Ultrasound