Bilgisayarlı tomografide apendiks vermiformis lokalizasyonunun belirlenmesinde referans olarak vertebraların ve iliak kemiğin kullanılması
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Tarih
2020
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Çanakkale Onsekiz Mart Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada amacımız bilgisayarlı tomografide appendiks vermiformisi vertebralar ve sağ iliak kemiği referans alarak lokalize edip apandisit ön tanısı ile yapılacak BT tetkikinde seçili hasta grubuna bu lokalizasyondan görüntüleme yapılarak mevcut rutin olan tüm abdomene yönelik inceleme yerine daha dar bir bölgenin görüntülenerek hastanın alacağı radyasyon dozu maruziyetinin azaltılmasını sağlamaktır. Metod: Ocak 2015-Ocak 2018 tarihleri arasında karın ağrısı nedeniyle Çanakkale Onsekiz Mart Üniversitesi Sağlık Uygulama ve Araştırma Hastanesi Acil Servisine başvuran 427 hastanın iv kontrastlı ve kontrastsız BT görüntüleri retrospektif olarak incelendi. Vertebralara ve sağ iliak kemiğin en yüksek noktasına göre apendiks lokalizasyonu değerlendirildi. Bulgular: Apendiksin en yüksek olduğu nokta sağ iliak kemiğin en yüksek noktasına göre maksimum +87 mm, apendiksin en düşük olduğu nokta sağ iliak kemiğin en yüksek noktasına göre minimum –140 mm düzeyinde görüldü. Apendiksin seyrinde en yüksek olduğu nokta vertebral düzeye göre Seviye 2 (L2 vertebra ve L2-L3 intervertebral eklem mesafesi); apendiksin seyrinde en alçak olduğu nokta Seviye 10 (S5 ve koksigeal vertebralar düzeyi) olarak saptandı. Apendiksin seyrinde en yüksek olduğu nokta vertebral düzeye göre en sık %34.4 oranla Seviye 5'te (L5 vertebra ve L5-S1 intervertebral eklem mesafesi) , apendiksin seyrinde en düşük olduğu nokta vertebral düzeye göre en sık (%22.5) oranla Seviye 6'da (S1 vertebra düzeyi) saptandı. Hasta yaşı, boyu, vücut kitle indeksi ve visseral yağlı doku miktarı ile vertebra referans alınarak hesaplanan apendiks lokalizasyonu arasında anlamlı negatif korelasyon saptanırken; hasta yaşı, boyu ve vücut kitle indeksi ile sağ iliak kemik referans alınarak hesaplanan apendiks lokalizasyonu arasında anlamlı istatistiksel ilişki bulunmadı. Apendiks yönü %9.4 oranla desendan, %90.6 oranla asendan olarak görüldü. Sonuç: Populasyonda apendiks lokalizasyonunun vertebra ve sağ iliak kemik referans alınarak belirlenmesi neticesinde; akut apandisit ön tanılı hastalarda BT görüntüleme alanı rutin tüm abdomen BT'ye kıyasla küçültülüp hastanın maruz kalacağı radyasyon miktarının azaltılabileceği ve özellikle apendiks lokalizasyonunun bağımsız değişkenlerden etkilenmemesi nedeniyle iliak kemiğin referans anatomik yapı olarak vertebralara göre daha üstün olduğu sonucuna vardık. Anahtar kelimeler: Bilgisayarlı Tomografi, apendiks lokalizasyonu, akut apandisit, iliak kemik, vertebra
Aim: In this study, our aim is to reduce the exposure of the radiation dose that the patient will receive by displaying a narrower region instead of the examination of the entire routine abdomen, by localizing the appendix vermiformis on computed tomography with a reference to the vertebrae and right iliac bone. Method: Intravenous contrast enhanced and non-enhanced CT images of 427 patients admitted to Canakkale Onsekiz Mart University Hospital Emergency Department due to abdominal pain betweeen January 2015 and January 2018 were analyzed retrospectively. The appendix localization was evaluated according to the vertebrae and the highest point of the right iliac bone. Results: The highest point of the appendix was maximum +87 mm relative to the highest point of the right iliac bone, and the lowest point of the appendix was minimum -140 mm relative to the highest point of the right iliac bone. The highest point in the course of the appendix was Level 2 according to the vertebral level (L2 vertebra and L2-L3 intervertebral joint distance);and the lowest point in the course of the appendix was Level 10 (S5 vertebra and coccygeal vertebral levels). The highest point of the appendix was most commonly found at Level 5 (L5 vertebra and L5-S1 intervertebral joint distance) with a rate of %34.4. The lowest point of the appendix was most commonly found at Level 6 (S1 vertebra) with a rate of %22.5. While there was a significant negative correlation between patient age, height, body mass index, amount of visceral adipose tissue and appendix localization calculated by reference to the vertebra; there was no statistically significant relationship between patient age, height, body mass index and appendix localization calculated by reference to the right iliac bone. The appendix was found to be descending with a rate of 9.4%, and ascending with a rate of 90.6%. Conclusion: As a result of determining the localization of the appendix in the population with reference to the vertebra and right iliac bone; We concluded that, in patients with suspected acute appendicitis, the CT imaging area can be reduced compared to routine whole abdomen CT, thus the amount of radiation can be reduced. Iliac bone is superior to the vertebrae as the reference anatomical structure, especially since the appendix localization is not affected by independent variables. Key Words: Computerized Tomography, localization of appendix vermiformis, acute appendicitis, iliac bone, vertebrae
Aim: In this study, our aim is to reduce the exposure of the radiation dose that the patient will receive by displaying a narrower region instead of the examination of the entire routine abdomen, by localizing the appendix vermiformis on computed tomography with a reference to the vertebrae and right iliac bone. Method: Intravenous contrast enhanced and non-enhanced CT images of 427 patients admitted to Canakkale Onsekiz Mart University Hospital Emergency Department due to abdominal pain betweeen January 2015 and January 2018 were analyzed retrospectively. The appendix localization was evaluated according to the vertebrae and the highest point of the right iliac bone. Results: The highest point of the appendix was maximum +87 mm relative to the highest point of the right iliac bone, and the lowest point of the appendix was minimum -140 mm relative to the highest point of the right iliac bone. The highest point in the course of the appendix was Level 2 according to the vertebral level (L2 vertebra and L2-L3 intervertebral joint distance);and the lowest point in the course of the appendix was Level 10 (S5 vertebra and coccygeal vertebral levels). The highest point of the appendix was most commonly found at Level 5 (L5 vertebra and L5-S1 intervertebral joint distance) with a rate of %34.4. The lowest point of the appendix was most commonly found at Level 6 (S1 vertebra) with a rate of %22.5. While there was a significant negative correlation between patient age, height, body mass index, amount of visceral adipose tissue and appendix localization calculated by reference to the vertebra; there was no statistically significant relationship between patient age, height, body mass index and appendix localization calculated by reference to the right iliac bone. The appendix was found to be descending with a rate of 9.4%, and ascending with a rate of 90.6%. Conclusion: As a result of determining the localization of the appendix in the population with reference to the vertebra and right iliac bone; We concluded that, in patients with suspected acute appendicitis, the CT imaging area can be reduced compared to routine whole abdomen CT, thus the amount of radiation can be reduced. Iliac bone is superior to the vertebrae as the reference anatomical structure, especially since the appendix localization is not affected by independent variables. Key Words: Computerized Tomography, localization of appendix vermiformis, acute appendicitis, iliac bone, vertebrae
Açıklama
Tıp Fakültesi, Radyoloji Ana Bilim Dalı
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
