Role of Duplex Doppler in Accurate Diagnosis of Appendicitis

Study Overview
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Brief Summary
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To evaluate the role of duplex doppler in diagnosis of appendicitis compared to CT

Detailed Description
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Acute appendicitis (AA) is the most common acute abdominal condition worldwide [1] Thus far, the clinical diagnosis of (AA) remains a challenge to emergency physicians and surgeons both in the pediatric and adult populations, as the symptoms are often atypical and overlapped with various other diseases[2],[3]. The accurate diagnosis of AA depends on both clinical presentations and imaging techniques. To date, US and computed tomography (CT) remain the most common used diagnostic imaging, and CT is considered the gold standard technique to evaluate patients with suspected AA, because of its high sensitivity and specificity [2],[3]. While the associated radiation exposure remains a concern, especially, among children, the elderly and pregnant women, as radiation protection is of major importance [2],[3],[5],[6]. Over recent years, research on various aspects of US imaging in the diagnosis of (AA) has gained major importance due to its radiation protection, broad availability and cost-effectiveness [6]. Therefore,US may be valuable as an initial imaging choice for patients with suspected (AA) or with equivocal clinical presentations [7],[8]. With continuing efforts to improve the diagnostic performance of US, a variety of US findings have been described for use in the setting of suspected appendicitis, including the maximum outer diameter (MOD), periappendiceal fluid, echogenic periappendiceal fat, and loss of the normally echogenic submucosal layer within the appendiceal wall [9] ,[10]. Color Doppler imaging has been utilized as well, with early reports describing no detectable flow in the normal appendix and later reports, with the benefit of improved instrumentation, d describing flow in normal appendices and hyperemia in inflamed appendices [11],[12]. However, objective criteria for interpreting Doppler results generally have not been specifically described [11],[13],[12],[14]. .Spectral Doppler imaging, in contrast to color Doppler imaging, provides inherently objective, quantitative data such as peak systolic velocity (PSV) and resistive index (RI) values. These measurements have found utility in the assessment of the carotid arteries and, for example, both native as well as transplanted hepatic and renal vessels[16],[17]. Early investigations addressed the RI in appendicitis as well, without emphasis on the PSV, using instrumentation that was modern for the time [18],[19],[20].

Official Title
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Role of Duplex Doppler In Diagnosis of Acute Appendicitis : in Correlation With Surgical Management Outcome

Conditions
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Appendicitis Acute

Intervention / Treatment
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* Device: duplex doppler ultra sound and CT


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with acute abdomen and suspected appendicitis. Exclusion Criteria: so Obese and irritable Patients whom satisfactory graded compression US can't be done. pregnant women , children under 3 years old and adults over 60 years old for radiation hazards. patients with renal impairment for contrast hazards.

Ages Eligible for Study
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Minimum Age: 3 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Intervention/Treatment |
| --- |
|Device: duplex doppler ultra sound and CT|graded compression US done in different positions then take MSCT with contrast on abdomen to compare with|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| comparison of duplex Doppler results with CT results | PSV = peak systolic velocity in cm/second , PDV =peak diastolic velocity in cm/second, and PI =( PSV - PDV)/ PSV taken from the intra mural appendiceal artery then compare with the results of MSCT with contrast of the abdomen. | baseline |