45° FLEXION ANTEROPOSTERIOR ELBOW RADIOGRAPHS IMPROVE DIAGNOSTIC ACCURACY OF CAPITELLUM OSTEOCHONDRITIS DISSECANS

Background: The initial diagnosis of capitellum osteochondritis dissecans (OCD) is typically confirmed using standard anteroposterior (AP) and lateral elbow radiographs, despite low sensitivity, which is approximately 44-47%. An AP image of the elbow in 45° of flexion has been suggested to increase diagnostic accuracy. Purpose: To assess the diagnostic performance, inter- and intra-observer reliability, and confidence level for identifying capitellum OCD using plain radiographs (AP, lateral, and 45° flexion AP) in pediatric and adolescent patients. Methods: This was a retrospective study including pediatric and adolescent patients with capitellum OCD and a healthy control group. Independent clinicians were blinded to the official radiologists’ reports and reviewed images on a picture archiving and communication system on two separate occasions 1 week apart. A 5-point Likert scale was used to assess the clinicians’ level of confidence (1-not at all confident; 5-very confident). Inter- and intraobserver reliability was determined using kappa statistics. Results: The study included 28 elbows (24 patients) with a mean age of 12.5 ± 2.0 years. 64.3% were female. There were no differences in age ( P = 0.18), sex ( P = 0.62), or laterality ( P = 1.0) between the two groups. There were marked variations in the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for each of the following views: AP: Sensitivity 85.1; Specificity 89.3; PPV 88.8; NPV 85.7; accuracy 87.2. Lateral: Sensitivity 73.2; Specificity 91.7; PPV 89.8; NPV 77.4; accuracy 82.4. 45° flexion AP: Sensitivity 91.7; Specificity 91.1; PPV 91.1; NPV 91.6; accuracy 91.4. Standard radiographs (AP and lateral views) failed to diagnose capitellum OCD in 4.8% of cases. The sensitivity of the three combined views was 100%. Confidence levels in the clinicians’ diagnostic assessments were similar for each view (AP, 4.0; lateral, 4.0; and 45° flexion AP, 4.1). Interobserver reliability was substantial for AP and lateral views (k=0.65 and k=0.60, respectively) but highest for the 45° flexion AP radiographs (k=0.72). Intraobserver reliability for all views was moderate to perfect (k=0.52 to 0.93). Conclusion: The 45° flexion AP view can detect capitellum OCD with excellent accuracy, a high level of confidence, and substantial interobserver agreement. When added to standard AP and lateral radiographs, capitellum OCD can be diagnosed in 100% of cases.

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Association Between 45° Flexion Anteroposterior Elbow Radiographs and Diagnostic Accuracy of Capitellum Osteochondritis Dissecans

The American Journal of Sports Medicine ◽

10.1177/03635465211027178 ◽

2021 ◽

pp. 036354652110271

Author(s):

Michael G. Saper ◽

Viviana Bompadre ◽

Gregory A. Schmale ◽

Sarah Menashe ◽

Monique Burton ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Osteochondritis Dissecans ◽

Predictive Value ◽

Interobserver Reliability ◽

Intraobserver Reliability ◽

Control Group ◽

Level Of Evidence ◽

Level Of Confidence ◽

High Level ◽

Sensitivity Specificity

Background: An anteroposterior (AP) radiograph of the elbow in 45° of flexion has been suggested to increase the diagnostic accuracy of capitellum osteochondritis dissecans (OCD). Purpose: To assess the diagnostic performance, inter- and intraobserver reliability, and confidence level for identifying capitellum OCD using plain radiographs (AP, lateral, and 45° flexion AP). Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: This was a retrospective study of pediatric and adolescent patients with capitellum OCD and a control group. Six independent clinicians who were blinded to the official radiologists’ reports reviewed images on 2 separate occasions, 1 week apart. A 5-point Likert scale was used to assess the clinicians’ level of confidence. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for individual and combinations of radiographic views. Inter- and intraobserver reliability was determined using Cohen kappa (κ) coefficients. Results: A total of 28 elbows (mean age, 12.5 ± 2 years) were included. There were no differences in age ( P = .18), sex ( P = .62), or laterality ( P > .999) between groups. There were marked variations in the diagnostic accuracy between views: sensitivity (AP, 85.1; lateral, 73.2; 45° flexion AP, 91.7), specificity (AP, 89.3; lateral, 91.7; 45° flexion AP, 91.1), PPV (AP, 88.8; lateral, 89.8; 45° flexion AP, 91.1), NPV (AP, 85.7; lateral, 77.4; 45° flexion AP, 91.6), and accuracy (AP, 87.2; lateral, 82.4; 45° flexion AP, 91.4). Standard radiographs (AP and lateral views) failed to diagnose capitellum OCD in 4.8% of cases. The sensitivity of the 3 combined views was 100%. Confidence intervals in the clinicians’ diagnostic assessments were similar for each view (AP, 4.0; lateral, 4.0; and 45° flexion AP, 4.1). Interobserver reliability was substantial for AP and lateral views (κ = 0.65 and κ = 0.60, respectively) but highest for the 45° flexion AP radiographs (κ = 0.72). Intraobserver reliability for the 45° flexion AP view was moderate to almost perfect (κ = 0.45 to 0.93). Conclusion: The 45° flexion AP view can detect capitellum OCD with excellent accuracy, a high level of confidence, and substantial interobserver agreement. When added to standard AP and lateral radiographs, the 45° flexion AP view aids in the identification of capitellum OCD.

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Accuracy and Interobserver Reliability of Magnetic Resonance Imaging for Placenta Accreta Spectrum Disorders

American Journal of Perinatology ◽

10.1055/s-0040-1701196 ◽

2020 ◽

Author(s):

Brett D. Einerson ◽

Christina E. Rodriguez ◽

Robert M. Silver ◽

Meghan A. Donnelly ◽

Anne M. Kennedy ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Predictive Value ◽

Placenta Accreta ◽

Interobserver Reliability ◽

Diagnostic Testing ◽

Kappa Statistics ◽

Resonance Imaging ◽

Mri Findings ◽

Placenta Accreta Spectrum

Abstract Objective This study aims to define the accuracy, predictive value, and interobserver reliability of magnetic resonance imaging (MRI) in the diagnosis of placenta accreta spectrum (PAS) disorders. Study Design Two experienced radiologists independently interpreted the MRI studies of patients with possible PAS from two referral centers. Radiologists were blinded to sonographic and clinical information. We calculated diagnostic testing characteristics and kappa statistics of interobserver reliability for MRI findings of PAS. Results Sixty-eight MRI cases were evaluated. Confirmed PAS and severe PAS were present in 44 (65%) and 20 (29%) cases. For the diagnosis of any PAS, MRI had a sensitivity 66%, specificity 71%, positive predictive value (PPV) 81%, negative predictive value (NPV) 53%, and accuracy 68%. For the diagnosis of severe PAS (percreta), MRI had a sensitivity 85%, specificity 79%, PPV 63%, NPV 93%, and accuracy 81%. The accuracy of individual signs of PAS was lower (44–65%). Interobserver agreement was almost perfect for previa; substantial for myometrial interruptions, PAS, severe PAS, and placental bulging/balling; and moderate to slight for other signs of PAS. Conclusion Although the interobserver reliability of MRI for a diagnosis of PAS is substantial, the accuracy and predictive value are modest and lower than previously reported.

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Comparison of Mammography and Ultrasonography in Evaluation of Breast Masses

Journal of Armed Forces Medical College Bangladesh ◽

10.3329/jafmc.v13i2.41368 ◽

2019 ◽

Vol 13 (2) ◽

pp. 22-24

Author(s):

Zebun Nahar ◽

Md Enamul Kabir ◽

Taharul Alam ◽

Shamoli Yasmin ◽

Maisha Naowar

Keyword(s):

Diagnostic Accuracy ◽

Predictive Value ◽

Breast Tumour ◽

Military Hospital ◽

Kappa Statistics ◽

K Value ◽

Breast Masses ◽

Malignant Breast ◽

Diagnostic Modalities ◽

Sensitivity Specificity

Introduction: Breast cancer is the most common cancer and second leading cause of cancer deaths in women. Early detection, efficient and accurate diagnosis can reduce the mortality rate. Objectives: To compare the screening accuracy of mammography (MMG) and ultrasonography (USG) in suspected cases of breast masses. Material and Methods: This cross-sectional analytical study was carried out in the Department of Radiology and Imaging, Combined Military Hospital, Dhaka from June 2016 to July 2017. A total of 100 clinically suspected case of breast masses aged from 20 to 75 years referred for MMG and USG was selected. Each patient underwent USG and MMG followed by a histopathological examination of the biopsy material taken from the lump lesion. Two cases histopathological report was not found. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of USG and MMG were compared with histopathology as the gold standard. In order to determine the agreement of diagnoses between USG and MMG, consistency analysis was performed using Kappa-statistics. Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG was 58.8%, 98.4%, 77.8%, 85.0% and 83.6% and for MMG 92.0%, 84.5%, 67.6%, 96.8% and 84.7% respectively. Kappa-statistics shows that the two diagnostic modalities had a test agreement in 39.8% cases to differentiate malignant breast tumour from the benign one (k-value = 0.398, p > 0.05). Conclusion: Two diagnostic modalities USG and MMG had a fair agreement in the differentiation of malignant breast tumour from the benign. Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 22-24

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Diagnostic accuracy of a new clinical test (resisted internal rotation) for detection of gluteus medius tears

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz046 ◽

2019 ◽

Vol 6 (4) ◽

pp. 398-405 ◽

Cited By ~ 4

Author(s):

Victor Ortiz-Declet ◽

Austin W Chen ◽

David R Maldonado ◽

Leslie C Yuen ◽

Brian Mu ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Internal Rotation ◽

Clinical Examination ◽

Predictive Value ◽

Gluteus Medius ◽

Control Group ◽

Case Group ◽

Lower Sensitivity ◽

Clinical Test ◽

Rotation Test

Abstract The objective of this study was to evaluate the diagnostic accuracy of a new dynamic clinical examination for detection of gluteus medius (GM) tears. A case group of 50 patients undergoing arthroscopy with GM repair was compared with a control group of 50 patients undergoing arthroscopy who had no peritrochanteric symptoms. Both groups were examined clinically, had magnetic resonance imaging studies performed and underwent arthroscopic surgery. Recorded clinical examinations included abnormal gait (Trendelenburg), tenderness to palpation of the greater trochanter, resisted abduction and the test being studied, resisted internal rotation. For all clinical tests, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy rates were calculated and compared with the arthroscopic and MRI data for the case group, and the MRI data for the control group. The resisted internal rotation test had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 88% in the detection of GM tears, with a low rate of false-positive and false-negative recordings. Other traditional clinical examination tests, with the exception of Trendelenburg gait, showed inferior rates. Trendelenburg gait had a higher specificity, but much lower sensitivity. The resisted internal rotation test aides in the detection of GM pathology. Due to the good results of the resisted internal rotation test in all the diagnostic parameters, we recommend incorporating it on the physical exam of patients with hip pain.

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COVID-19 Pneumonia: Inter-Observer Agreement and Diagnostic Accuracy of Chest CT in Patients with Intermediate Clinical Probability

10.21203/rs.3.rs-37489/v1 ◽

2020 ◽

Author(s):

Anne-Laure BRUN ◽

Alexia GENCE-BRENEY ◽

Julie TRICHEREAU ◽

Marie-Christine BALLESTER ◽

Marc VASSE ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Ct Scan ◽

Predictive Value ◽

Chest Ct ◽

Observer Agreement ◽

Kappa Statistics ◽

Operating Characteristics ◽

Rt Pcr ◽

Clinical Probability ◽

Chest Ct Scan

Abstract Objectives To assess inter-reader agreements and diagnostic accuracy of chest CT to identify COVID-19 pneumonia in patients with intermediate clinical probability during an acute disease outbreak.Methods:From March 20 to April 8, consecutive patients with intermediate clinical probability of COVID-19 pneumonia underwent a chest CT scan. Two independent chest radiologists blinded to clinical information and RT-PCR results retrospectively reviewed and classified images on a 1-5 confidence level scale for COVID-19 pneumonia. Agreements between radiologists were assessed with kappa statistics. Diagnostic accuracy of chest CT compared to RT-PCR assay and patient outcomes was measured using receiver operating characteristics (ROC). Positive predictive value (PPV) and negative predictive value (NPV) for COVID-19 pneumonia were calculated.Results: 319 patients with a mean age of 62.3 yo were included. Inter-observer agreement for highly probable (kappa: 0.83 [p < .001]) and highly probable or probable (kappa: 0.82 [p < .001]) diagnosis of COVID-19 pneumonia was very good. RT-PCR tests performed in 307 patients were positive in 173 and negative in 134. Sixteen patients with negative RT-PCR tests and probable or highly probable CT patterns according to both radiologists were reclassified COVID-19 positive after clinical discussion. The areas under the curve (AUC) were 0.94 and 0.92 respectively. With a disease prevalence of 61.6%, PPV were 96.6 % and 94.4%, and NPV 84.3% and 78.2%.Conclusion :During acute COVID-19 outbreak, chest CT scan may be used for triage of patients with intermediate clinical probability with very good inter-observer agreements and diagnostic accuracy.

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Detection of Atrial Fibrillation Using a Ring-Type Wearable Device (CardioTracker) and Deep Learning Analysis of Photoplethysmography Signals: Prospective Observational Proof-of-Concept Study (Preprint)

10.2196/preprints.16443 ◽

2019 ◽

Author(s):

Soonil Kwon ◽

Joonki Hong ◽

Eue-Keun Choi ◽

Byunghwan Lee ◽

Changhyun Baik ◽

...

Keyword(s):

Atrial Fibrillation ◽

Deep Learning ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Learning Algorithm ◽

Wearable Device ◽

Control Group ◽

Ring Type ◽

Deep Learning Algorithm ◽

Learning Analysis

BACKGROUND Continuous photoplethysmography (PPG) monitoring with a wearable device may aid the early detection of atrial fibrillation (AF). OBJECTIVE We aimed to evaluate the diagnostic performance of a ring-type wearable device (CardioTracker, CART), which can detect AF using deep learning analysis of PPG signals. METHODS Patients with persistent AF who underwent cardioversion were recruited prospectively. We recorded PPG signals at the finger with CART and a conventional pulse oximeter before and after cardioversion over a period of 15 min (each instrument). Cardiologists validated the PPG rhythms with simultaneous single-lead electrocardiography. The PPG data were transmitted to a smartphone wirelessly and analyzed with a deep learning algorithm. We also validated the deep learning algorithm in 20 healthy subjects with sinus rhythm (SR). RESULTS In 100 study participants, CART generated a total of 13,038 30-s PPG samples (5850 for SR and 7188 for AF). Using the deep learning algorithm, the diagnostic accuracy, sensitivity, specificity, positive-predictive value, and negative-predictive value were 96.9%, 99.0%, 94.3%, 95.6%, and 98.7%, respectively. Although the diagnostic accuracy decreased with shorter sample lengths, the accuracy was maintained at 94.7% with 10-s measurements. For SR, the specificity decreased with higher variability of peak-to-peak intervals. However, for AF, CART maintained consistent sensitivity regardless of variability. Pulse rates had a lower impact on sensitivity than on specificity. The performance of CART was comparable to that of the conventional device when using a proper threshold. External validation showed that 94.99% (16,529/17,400) of the PPG samples from the control group were correctly identified with SR. CONCLUSIONS A ring-type wearable device with deep learning analysis of PPG signals could accurately diagnose AF without relying on electrocardiography. With this device, continuous monitoring for AF may be promising in high-risk populations. CLINICALTRIAL ClinicalTrials.gov NCT04023188; https://clinicaltrials.gov/ct2/show/NCT04023188

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Detection of Atrial Fibrillation Using a Ring-Type Wearable Device (CardioTracker) and Deep Learning Analysis of Photoplethysmography Signals: Prospective Observational Proof-of-Concept Study

Journal of Medical Internet Research ◽

10.2196/16443 ◽

2020 ◽

Vol 22 (5) ◽

pp. e16443

Author(s):

Soonil Kwon ◽

Joonki Hong ◽

Eue-Keun Choi ◽

Byunghwan Lee ◽

Changhyun Baik ◽

...

Keyword(s):

Atrial Fibrillation ◽

Deep Learning ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Learning Algorithm ◽

Wearable Device ◽

Control Group ◽

Ring Type ◽

Deep Learning Algorithm ◽

Learning Analysis

Background Continuous photoplethysmography (PPG) monitoring with a wearable device may aid the early detection of atrial fibrillation (AF). Objective We aimed to evaluate the diagnostic performance of a ring-type wearable device (CardioTracker, CART), which can detect AF using deep learning analysis of PPG signals. Methods Patients with persistent AF who underwent cardioversion were recruited prospectively. We recorded PPG signals at the finger with CART and a conventional pulse oximeter before and after cardioversion over a period of 15 min (each instrument). Cardiologists validated the PPG rhythms with simultaneous single-lead electrocardiography. The PPG data were transmitted to a smartphone wirelessly and analyzed with a deep learning algorithm. We also validated the deep learning algorithm in 20 healthy subjects with sinus rhythm (SR). Results In 100 study participants, CART generated a total of 13,038 30-s PPG samples (5850 for SR and 7188 for AF). Using the deep learning algorithm, the diagnostic accuracy, sensitivity, specificity, positive-predictive value, and negative-predictive value were 96.9%, 99.0%, 94.3%, 95.6%, and 98.7%, respectively. Although the diagnostic accuracy decreased with shorter sample lengths, the accuracy was maintained at 94.7% with 10-s measurements. For SR, the specificity decreased with higher variability of peak-to-peak intervals. However, for AF, CART maintained consistent sensitivity regardless of variability. Pulse rates had a lower impact on sensitivity than on specificity. The performance of CART was comparable to that of the conventional device when using a proper threshold. External validation showed that 94.99% (16,529/17,400) of the PPG samples from the control group were correctly identified with SR. Conclusions A ring-type wearable device with deep learning analysis of PPG signals could accurately diagnose AF without relying on electrocardiography. With this device, continuous monitoring for AF may be promising in high-risk populations. Trial Registration ClinicalTrials.gov NCT04023188; https://clinicaltrials.gov/ct2/show/NCT04023188

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Cerebroumbilical doppler ratio in pregnancy induced hypertension and its prediction for adverse perinatal outcome

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20195359 ◽

2019 ◽

Vol 8 (12) ◽

pp. 4995

Author(s):

Meena Bhati Salvi

Keyword(s):

Diagnostic Accuracy ◽

Negative Predictive Value ◽

Doppler Ultrasound ◽

Predictive Value ◽

Perinatal Outcome ◽

Control Group ◽

Study Group ◽

Pregnancy Induced Hypertension ◽

Adverse Perinatal Outcome ◽

Induced Hypertension

Background: To compare the changes in pulsatility index (PI) values of fetal middle cerebral artery (MCA), umbilical artery (UA) and ratio of PI of MCA and UA (cerebroumbilical ratio, C/U ratio) in normal pregnancies with pregnancy induced hypertension (PIH) and to evaluate their usefulness for predicting adverse perinatal outcome.Methods: This was a prospective comparative study carried out over a period of 1 year on total 140 patients between 30-40 weeks of gestation. Study group comprised of 70 patients with PIH. The control group comprised of 70 patients with normal BP. Both the groups were followed by doppler ultrasound and the UA PI, the MCA PI and the C/U ratio were measured. The results of the last doppler ultrasound before delivery were considered in the correlation with various adverse perinatal outcome. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of MCA PI and UA PI and C/U ratio were calculated and compared for predicting adverse perinatal outcome.Results: Abnormal C/U ratio was more common in PIH group (42.85%) than control group (5.71%). In the study group, 83.33% patients of abnormal C/U ratio showed adverse perinatal outcome. C/U ratio had highest sensitivity (75.75%), negative predictive value (80%) and diagnostic accuracy (81.42%) compared to MCA PI and UA PI for predicting adverse perinatal outcome in PIH women.Conclusions: Incidence of adverse perinatal outcome was more common with abnormal C/U ratio. C/U ratio is better predictor for adverse perinatal outcome in PIH women than individual MCA PI and UA PI.

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Study of CSF C-reactive protein in meningitis to differentiate bacterial meningitis from aseptic meningitis in children between 1 month and 12 years of age

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20171703 ◽

2017 ◽

Vol 4 (3) ◽

pp. 943

Author(s):

Bhagwan S. Natani ◽

Pardeep Goyal ◽

Ankit Agarwal ◽

Sumit Bhatia ◽

Malvika Kumar

Keyword(s):

Bacterial Meningitis ◽

Diagnostic Accuracy ◽

Aseptic Meningitis ◽

Predictive Value ◽

Confirmatory Test ◽

Control Group ◽

Predictive Values ◽

Group 2 ◽

Meningitis In Children ◽

Sensitivity Specificity

Background: Meningitis is a serious illness of childhood. CSF Gram stain and culture is the gold standard for diagnosis which is a costly and time consuming. So, this study was conducted with the objective to measure the specificity, sensitivity, positive and negative predictive values and diagnostic accuracy of CSF-CRP in the diagnosis of bacterial meningitis.Methods: This prospective study was conducted in Department of Pediatrics, National Institute of Medical Sciences and Research, Jaipur. Children between 1 month to 12 years of age admitted with acute history of fever and seizure were included. CSF was sent for CRP estimation and other laboratory investigations. CSF CRP was determined qualitatively and value >6mcg/ml was considered positive. Patients were divided into three groups based on clinical and CSF findings. Group 1 (Bacterial meningitis), Group 2 (Aseptic Meningitis) and Group 3 (No meningitis/Control Group). Statistical analysis was done using software SPSS version 23.Results: 120 patients were enrolled in our study. 65% of our cases were males. The mean age of our cases was 74.9±39.8 months. 48 cases had bacterial meningitis, 42 cases had Aseptic Meningitis and 30 cases had no meningitis. CSF-CRP was positive in 35 cases of Bacterial meningitis, 6 cases of aseptic meningitis and negative in all cases of control group. Hence the Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value and Diagnostic Accuracy of CSF-CRP for diagnosis of bacterial meningitis were 72.92%, 85.71%, 85.71%, 73.47% and 78.89% respectively. CSF-CRP cases of bacterial meningitis were also found to have a poor outcome.Conclusions:CSF-CRP can be used as an initial test for the diagnosis of Bacterial Meningitis till other confirmatory test reports are awaited.

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Comparative Study between Neopterin and Alvarado Score in the Diagnosis of Acute Appendicitis and Its Severity

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2021.5465 ◽

2021 ◽

Vol 9 (B) ◽

pp. 42-47

Author(s):

Zuhair B. Kamal ◽

Raghad E. Naji ◽

Hiba A. Ali

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Predictive Value ◽

Histopathological Examination ◽

Perforated Appendicitis ◽

Signs And Symptoms ◽

Complex Case ◽

Control Group ◽

Negative Appendectomy ◽

Alvarado Score

BACKGROUND: Acute appendicitis (AA) remains a complex case even for experienced surgeons. Rate of negative appendectomy is 5–40% and delayed intervention result in perforated appendicitis in 5–30% of cases. AIM: The aim of the study was to evaluate NPT as a marker for the diagnosis of AA concerning its severity. And compare the diagnostic value of it with the ALV scoring system. METHODS: One hundred twenty patients presented with signs and symptoms of AA and underwent appendectomy, only 84 patients proved to be AA by histopathological examination, were included in the study. Blood samples for neopterin (NPT) estimation and Alvarado (ALV) score was calculated. Control group consists of 45 healthy individual. RESULTS: NPT levels were significantly higher in patients’ group than control with p = 0.001 at a cutoff point 5.3 nmol/L. The diagnostic accuracy of NPT was higher than ALV score. NPT sensitivity, specificity, positive predictive value, and negative predictive value were 85.4%, 76.9%, 89%, and 70%, respectively. CONCLUSION: NPT significantly elevated in patient with AA and has a high diagnostic accuracy, with correlation to clinical features and severity of the inflammation.

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