{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T20:31:06Z","timestamp":1775075466897,"version":"3.50.1"},"reference-count":39,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2020,7,22]],"date-time":"2020-07-22T00:00:00Z","timestamp":1595376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To test the hypothesis that abutting and encasing types of hyperechoic periappendiceal fat are specific sonographic indicators of appendicitis in pediatric patients, including individuals with maximum outer diameters (MODs) of 6 to 8\u2009mm in whom diagnosis by the MOD alone is known to be equivocal.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Appendiceal sonograms of 271 consecutive pediatric patients were retrospectively evaluated for hyperechoic periappendiceal fat (globular, \u22651.0\u2009cm; categorized as type 0, none; type 1, \u201cabutting,\u201d encompassing &lt;180\u00b0 of the appendiceal circumference; or type 2, \u201cencasing,\u201d encompassing 180\u00b0 or more of the appendiceal circumference) and the MOD. Histopathologic and medical records constituted reference standards. Statistical methods included the binomial distribution, logistic regression, a receiver operating characteristic analysis, and the exact McNemar test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All patients with hyperechoic fat and 105 of 107 patients with appendicitis had MODs of 6\u2009mm or greater. The MOD and fat types 1 and 2 each were significantly associated with appendicitis in the univariable regression. The MOD and fat type 1 were independently associated with appendicitis in multivariable regression (odds ratio, 24.97; <jats:italic>P<\/jats:italic> = .034; and odds ratio, 5.35; <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001, respectively). Specificities of an MOD of 6 to 8\u2009mm and an MOD of 6\u2009mm or greater alone were 89.0% (95% confidence interval, 83.2%\u201393.4%); these increased to 100.0% each (95% confidence interval, 97.8%\u2013100.0%; <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001) when combined with fat types 1, 2, and either 1 or 2 as diagnostic criteria, with positive predictive values of 100.0%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Types 1 and 2 periappendiceal fat are specific indicators of appendicitis, and both improve specificity compared to the MOD. Importantly, they add specificity in diagnosing appendicitis in patients with diagnostically equivocal MODs of 6 to 8\u2009mm.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jum.15399","type":"journal-article","created":{"date-parts":[[2020,7,22]],"date-time":"2020-07-22T13:25:54Z","timestamp":1595424354000},"page":"285-296","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Hyperechoic Periappendiceal Fat"],"prefix":"10.1002","volume":"40","author":[{"given":"Ryan","family":"Penticuff","sequence":"first","affiliation":[{"name":"Department of Radiology Stanford University School of Medicine  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. Brooke","family":"Jeffrey","sequence":"additional","affiliation":[{"name":"Department of Radiology Stanford University School of Medicine  Stanford California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6144-5466","authenticated-orcid":false,"given":"Eric W.","family":"Olcott","sequence":"additional","affiliation":[{"name":"Department of Radiology Stanford University School of Medicine  Stanford California USA"},{"name":"Veterans Affairs Palo Alto Health Care System  Palo Alto California 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