Diagnostic accuracy using low-dose versus standard radiation dose CT in suspected acute appendicitis: prospective cohort study

Abstract

Background Contrast-enhanced CT is the reference standard used in diagnostic imaging for acute appendicitis in adults. The radiation dose has been of concern. This study aimed to assess whether a lower radiation dose would affect the diagnostic accuracy of CT. Methods This was a prospective single-centre cohort study of patients (aged over 16 years) with suspected appendicitis evaluated for enrolment in concurrent APPAC II–III trials. The diagnostic accuracy of contrast-enhanced low- and standard-dose CT was compared with study protocols guiding imaging based on BMI; this enabled direct CT imaging comparison only in patients with a BMI below 30 kg/m2. The on-call CT diagnosis was compared with the final clinical diagnosis. Results Among all 856 patients investigated, the accuracy of low-dose (454 patients) and standard-dose (402 patients) CT in identifying patients with and without appendicitis was 98·0 and 98·5 per cent respectively. In patients with a BMI under 30 kg/m2, respective values were 98·2 per cent (434 patients) and 98·6 per cent (210 patients) (P = 1·000). The corresponding accuracy for differentiating between uncomplicated and complicated acute appendicitis was 90·3 and 87·6 per cent in all patients, and 89·8 and 88·4 per cent respectively among those with a BMI below 30 kg/m2 (P = 0·663). The median radiation dose in the whole low- and standard-dose CT groups was 3 and 7 mSv respectively. In the group with BMI below 30 kg/m2, corresponding median doses were 3 and 5 mSv (P < 0·001). Conclusion Low- and standard-dose CT were accurate both in identifying appendicitis and in differentiating between uncomplicated and complicated acute appendicitis. Low-dose CT was associated with a significant radiation dose reduction, suggesting that it should be standard clinical practice at least in patients with a BMI below 30 kg/m2.

Multicenter cohort study on the presentation and treatment of acute appendicitis during the COVID-19 pandemic

“…Despite the exposure of patients to ionizing radiation, the use of a CT as first-line imaging for evaluating acute abdominal pain has been advocated before, given its higher accuracy compared to US [ 29 ]. Moreover, Haijanen et al reported the use of low dose ionizing radiation in CT as still accurate in identifying an acute appendicitis [ 30 ].…”

Apendicite Aguda: Abordagem Diagnóstica E Avanços No Tratamento Cirúrgico.

“…Um estudo publicado na British Journal of Surgery em 2021 destaca que a TC de baixa dose é quase tão precisa quanto a TC de dose padrão na identificação de apendicite aguda, mas com uma exposição significativamente menor à radiação. Este estudo apoia a implementação ativa de modalidades de baixa dose na prática clínica para minimizar a exposição à radiação, mantendo a precisão diagnóstica e ajudando a reduzir as apendicectomias negativas(Haijanen et al , 2021). Além disso, artigo da BMC Gastroenterology de 2023 discute um novo escore de apendicite adulta que melhora a precisão diagnóstica.…”