Ozturk MO, Resorlu M, Aydin S, Memis KB. Use of the vertebrae and iliac bone as references for localizing the appendix vermiformis in computed tomography. World J Radiol 2024; 16(11): 629-637 [PMID: 39635315 DOI: 10.4329/wjr.v16.i11.629]
Corresponding Author of This Article
Muhsin Ozgun Ozturk, MD, Researcher, Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Başbağlar, Hacı Ali Akın Cd. No. 32 24100 Erzincan Merkez/Erzincan, Erzincan 24000, Türkiye. ozturk_bul@hotmail.com
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Radiol. Nov 28, 2024; 16(11): 629-637 Published online Nov 28, 2024. doi: 10.4329/wjr.v16.i11.629
Use of the vertebrae and iliac bone as references for localizing the appendix vermiformis in computed tomography
Muhsin Ozgun Ozturk, Mustafa Resorlu, Sonay Aydin, Kemal Bugra Memis
Muhsin Ozgun Ozturk, Sonay Aydin, Kemal Bugra Memis, Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Erzincan 24000, Türkiye
Mustafa Resorlu, Department of Radiology, Canakkale Onsekiz Mart University, Faculty of Medicine, Canakkale 17000, Türkiye
Author contributions: Ozturk MO and Resorlu M designed and performed research, analyzed the data, and added radiological images; Ozturk MO and Aydin S wrote the manuscript; Ozturk MO and Memis KB revised the manuscript.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee of Canakkale Onsekiz Mart University Ethics Committee of Clinical Research (2011-KAEK-27/2019-E.1900162336).
Informed consent statement: Owing to the methodology of the study, the requirement for obtaining patient consent was waived by the ethics committee.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The datasets generated and/or analyzed during the current study are not publicly available due to the risk of breach of patient data privacy but are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Muhsin Ozgun Ozturk, MD, Researcher, Department of Radiology, Erzincan Binali Yıldırım University, Faculty of Medicine, Başbağlar, Hacı Ali Akın Cd. No. 32 24100 Erzincan Merkez/Erzincan, Erzincan 24000, Türkiye. ozturk_bul@hotmail.com
Received: March 15, 2024 Revised: October 1, 2024 Accepted: November 8, 2024 Published online: November 28, 2024 Processing time: 257 Days and 2.3 Hours
Abstract
BACKGROUND
The appendix vermiformis is a part of the gastrointestinal tract, situated in the lower right quadrant of the abdomen. Acute appendicitis, acute inflammation of the appendix vermiformis, is the most common cause of acute abdomen requiring surgical intervention. Although computed tomography (CT) offers high diagnostic efficacy in assessing the appendix across various anatomical positions, it also involves radiation exposure. Reducing exposure factors and narrowing the field of view (FOV) are ways to decrease the radiation dose to the patient. To narrow the FOV, appendix locations within the population must be defined using metric markers.
AIM
To determine the location of the appendix vermiformis on CT using the vertebrae and the right iliac bone as anatomical landmarks.
METHODS
This retrospective study examined 470 patients presenting with abdominal pain who underwent abdominal CT scans between January 01, 2015 and January 01, 2018. Forty-three patients were excluded due to various reasons. The most superior and inferior points and the origin of the appendix were measured separately in relation to the vertebrae and right iliac bone for localization. The population was divided into normal and acute appendicitis groups, and the relationship between appendix location and anthropometric parameters relationship was examined. P values below 0.05 were considered statistically significant.
RESULTS
The final analysis included 427 adult patients (206 females and 221 males) with a mean age of 42.1 ± 19.5 years. An ascending appendix course was the most common (90.4%). The appendix ranged from the L2 vertebral body level to the coccygeal vertebral level relative to the vertebrae. The appendix ranged between (−) 140.5 mm and (+) 87.4 mm relative to the right iliac bone. A negative correlation was found between patient age, height, body mass index, and the highest and lowest points of the appendix in regard to the vertebrae.
CONCLUSION
The study’s findings unveiled the locations of the appendix in the population in relation to the bony anatomical landmarks. These data can be used as the basis for future research aimed at reducing patient exposure to ionizing radiation.
Core Tip: It is important to determine the location of the appendix vermiformis in the population using anatomical reference points. Therefore, when there is a suspicion of acute appendicitis and computed tomography is required, the field of view can be adjusted accordingly, potentially reducing the radiation dose given to the patient. Utilizing bony structures as references may offer some advantages. In particular, using the iliac bone as a reference, as opposed to the vertebrae, appears to be a more efficient approach because it is not affected by variables such as age, sex, and body mass index.
