Negative Appendectomy Rate in the Era of CT: An 18-year Perspective

Raja, Ali S.; Wright, Christopher; Sodickson, Aaron; Zane, Richard D.; Schiff, Gordon D.; Hanson, Richard W.; Baeyens, Pieter F.; Khorasani, Ramin

doi:10.1148/radiol.10091570

Cited by 264 publications

(191 citation statements)

References 19 publications

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“…The rate of negative appendectomies has fallen. This change has also been observed by others [4,5]. The incidence of appendectomies performed is relatively steady in our series, while some report a decrease in the number of appendectomies with increasing use of US and CT [4].…”

Section: Disclosuresupporting

confidence: 87%

“…To help improve clinical diagnostic accuracy, various scoring systems have been proposed, such as Alvarado-score, de Dombal score, and RIPASA score [3,4]. Recent trials showed that an increased use of preoperative CT and Ultrasonography (US) greatly benefits the clinician in establishing a correct preoperative diagnosis, decreases the Negative Appendectomy Rate (NAR) by avoiding unnecessary surgery, and reduces the number of appendectomies [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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2017

Int J Surg Res Pract

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Section: Disclosuresupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Untitled

2017

Int J Surg Res Pract

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“…CT-A/P has become an important diagnostic tool to diagnose or exclude acute appendicitis, with a sensitivity and negative predictive value that surpasses compression sonography and clinical exam [4][5][6][7]. The rates of negative appendectomies have decreased from up to 20% to as low as 1.7% when using preoperative CT scans [8,9]. Evaluation of equivocal CT-A/P studies in patients with right lower quadrant pain and suspected appendicitis may benefit from subspecialist consultation, particularly in the academic setting where preliminary interpretations are carried out by resident physicians [6,10,11].…”

Section: Introductionmentioning

confidence: 99%

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Choudhri

Carr

et al. 2011

J Digit Imaging

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Advances in handheld computing now allow review of DICOM datasets from remote locations. As the diagnostic ability of this tool is unproven, we evaluated the ability to diagnose acute appendicitis on abdominal CT using a mobile DICOM viewer. This HIPAA compliant study was IRB-approved. Twenty-five abdominal CT studies from patients with RLQ pain were interpreted on a handheld device (iPhone) using a DICOM viewer (OsiriX mobile) by five radiologists. All patients had surgical confirmation of acute appendicitis or follow-up confirming no acute appendicitis. Studies were evaluated for the ability to find the appendix, maximum appendiceal diameter, presence of an appendicolith, periappendiceal stranding and fluid, abscess, and an assessment of the diagnosis of acute appendicitis. Results were compared to PACS workstation. Fifteen cases of acute appendicitis were correctly identified on 98% of interpretations, with no false-positives. Eight appendicoliths were correctly identified on 88% of interpretations. Three abscesses were correctly identified by all readers. Handheld device measurement of appendiceal diameter had a mean 8.6% larger than PACS measurements (p=0.035). Evaluation for acute appendicitis on abdominal CT studies using a portable device DICOM viewer can be performed with good concordance to reads performed on PACS workstations.

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“…This is predominantly due to the growing body of evidence that suggests lower negative appendectomy rates after increasing the use of MDCT in patients with acute abdomen. One study reported a 93% reduction in negative appendectomy rates with a corresponding increase in the number of patients undergoing a preoperative CT for appendicitis, from 1% to 97.5% over an 18-year period (6).…”

Section: Discussionmentioning

confidence: 99%

‘surface map’ of appendix – a novel tool for pre-operative demonstration of appendicular location with reference to mcburney’s point using multi-detector ct.

Ghonge¹,

Setia²,

Aggarwal³

2012

Diagn Interv Radiol

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According to conventional teaching in surgical practice, McBurney's point is the anatomical landmark for locating the appendix and is commonly described as the junction of the lateral and middle thirds of the line joining the right anterior superior iliac spine and the umbilicus (1). Several studies have, however, suggested a significant discrepancy between the McBurney's point and the exact anatomical location of the appendix (2, 3). Multidetector computed tomography (MDCT) is a "one-stop" imaging solution for effective diagnosis of acute appendicitis, with a sensitivity and specificity ranging from 87%−100% and 89%−99%, respectively (4). Similar to the way surgeons use McBurney's point to decide the site of an open appendicectomy incision, the MDCT "surface map" provides a representation of the appendicular base over the anterior abdominal wall in a single image.The present study evaluated the role of MDCT "surface mapping" of the appendix in demonstrating the variation in the location of the appendicular base with reference to McBurney's point and also to anticipate the surgical implications of these results in patients with acute appendicitis. Materials and methodsThis prospective study included a total of 74 patients who had MDCT (Somatom Sensation Cardiac 64 CT scanner, Siemens AG Healthcare, Erlangen, Germany) of the abdomen for varied clinical indications over a period of two months. Patients with a clinical history of any abdominal surgery, systemic malignancy, radiotherapy, or tuberculosis were excluded. A contrast-enhanced CT study of the abdomen was performed in venous phase with a data acquisition time of 6.15 s, scan delay of 60 s, beam collimation of 0.6 mm, gantry rotation time of 0.5 s, and pitch of 1.15. The peak tube voltage range was 100−120 kV, and the current range was 180-225 mAs, using the "care-dose" technique. The images were reconstructed at 3 mm thicknesses in the axial, sagittal, and coronal planes. Because the study did not affect the routine filming and reporting pattern, no ethical approval was required. Post-processing of the MDCT data was performed using the INSPACE software (Siemens AG Healthcare) and a "surface map" was reconstructed with a superimposed measurement grid. The software utilized the volume rendering technique (VRT) of MDCT. A detailed step-wise algorithm with explanatory images is shown in Fig. 1. An illustrative MDCT "surface map" is shown in Fig. 2. The "zero" of the measurement grid corresponded to the umbilicus on the "surface map" image. Post-processing was performed by a single CT technologist, under the direct supervision of the radiologist. The variations in the location of the appendicular base with reference to McBurney's point were tabulated along the cranio-caudal and medio-lateral axes. The location of the appendicular base along MATERIALS AND METHODSThis prospective study included a total of 74 patients who underwent an MDCT study of the abdomen for various clinical indications. Post-processing of the data was performed and a "surface map" of the a...

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Negative Appendectomy Rate in the Era of CT: An 18-year Perspective

Abstract: There was a significant reduction in both the NAR and the number of appendectomies in patients who presented to the emergency department during an 18-year period, which was associated with a significant increase in the use of preoperative abdominal CT.

Cited by 264 publications

References 19 publications

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Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

‘surface map’ of appendix – a novel tool for pre-operative demonstration of appendicular location with reference to mcburney’s point using multi-detector ct.

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