Neutral<i>vs</i>positive oral contrast in diagnosing acute appendicitis with contrast-enhanced CT: sensitivity, specificity, reader confidence and interpretation time

Naeger, David M.; Chang, Shuenn‐Dyh; Kolli, P; Shah, Veeraj; Huang, Wenjun; Thoeni, Ruedi F.

doi:10.1259/bjr/20854868

Cited by 13 publications

(2 citation statements)

References 25 publications

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“…As not all the missing data are due to missing CT scans, we can therefore only extrapolate that 45 CT scans were missed during follow-up as 29 % of our patients were investigated by CT scan (Table 1). Considering that the rate of false-positive CT scan is about 4 % according to the literature, two patients would have been missed, which should not impact our conclusions [29]. Although data was collected in all public hospitals covering an area of nearly half a million inhabitants, it remains unclear how many patients from outside this region were included.…”

Section: Discussionmentioning

confidence: 99%

Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications

Sauvain

Slankamenac

Müller

et al. 2016

Langenbecks Arch Surg

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Section: Discussionmentioning

confidence: 99%

Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications

Sauvain

Slankamenac

Müller

et al. 2016

Langenbecks Arch Surg

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“…Use of intravenous iodinated contrast is the standard imaging practices. Positive oral (high-attenuation) contrast, and positive rectal contrast, also have been recommended [2].…”

Section: Introductionmentioning

confidence: 99%

Role of Computed Tomography in Diagnosis of Appendicitis and Its Complications

Elghandour¹,

Shebrya²,

Abdelsamad³

2019

Zagazig University Medical Journal

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Background: Appendicitis and its complications are the most commonly acute abdominal pain that require surgical intervention. Patients may present with a wide variety of clinical manifestation. The clinical diagnosis is based primarily on the patient history, physical examinations and white blood cell count. Clinical diagnosis mostly straight forward in patients presenting with classic signs and symptoms, while diagnostic confusion and delay in treatment may occur in patients with atypical presentations. MSCT is a highly accurate means for establishing the diagnosis. Objective: The aim of the work is to describe the value and role of Multi-slice computed tomography in diagnosing appendicitis and its complications. Methods: This study retrospective study was conducted on patients with right lower quadrant or right flank pain. The study was conducted in Health Insurance hospitals Radiology department on Fifteen patients with right lower quadrant pain or right flank pain. Results: In the present study, we concentrate on continuity and thickness of the appendiceal wall. The normal appendix thickness is less than 1 mm. When appendix got inflamed, it usually appears thickened, asymmetric and enhancing with i.v. contrast from 1 to 3 mm thickness. Conclusion: MSCT is helpful for accurate and prompt diagnosis in suspected cases of appendicitis & its complications and conditions that mimic appendicitis.

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Computed tomography for diagnosis of acute appendicitis in adults

Rud

Vejborg

Rappeport

et al. 2019

Cochrane Database of Systematic Reviews

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Cochrane Database of Systematic Reviews Data collection and analysisTwo review authors independently collected the data from each study and evaluated methodological quality according to the Quality Assessment of Studies of Diagnostic Accuracy -Revised (QUADAS-2) tool. We used the bivariate random-e ects model to obtain summary estimates of sensitivity and specificity. Main resultsWe identified 64 studies including 71 separate study populations with a total of 10,280 participants (4583 with and 5697 without acute appendicitis). Estimates of sensitivity ranged from 0.72 to 1.0 and estimates of specificity ranged from 0.5 to 1.0 across the 71 study populations. Summary sensitivity was 0.95 (95% confidence interval (CI) 0.93 to 0.96), and summary specificity was 0.94 (95% CI 0.92 to 0.95). At the median prevalence of appendicitis (0.43), the probability of having appendicitis following a positive CT result was 0.92 (95% CI 0.90 to 0.94), and the probability of having appendicitis following a negative CT result was 0.04 (95% CI 0.03 to 0.05). In subgroup analyses according to contrast enhancement, summary sensitivity was higher for CT with intravenous contrast (0.96, 95% CI 0.92 to 0.98), CT with rectal contrast (0.97, 95% CI 0.93 to 0.99), and CT with intravenous and oral contrast enhancement (0.96, 95% CI 0.93 to 0.98) than for unenhanced CT (0.91, 95% CI 0.87 to 0.93). Summary sensitivity of CT with oral contrast enhancement (0.89, 95% CI 0.81 to 0.94) and unenhanced CT was similar. Results show practically no di erences in summary specificity, which varied from 0.93 (95% CI 0.90 to 0.95) to 0.95 (95% CI 0.90 to 0.98) between subgroups. Summary sensitivity for low-dose CT (0.94, 95% 0.90 to 0.97) was similar to summary sensitivity for standard-dose or unspecified-dose CT (0.95, 95% 0.93 to 0.96); summary specificity did not di er between lowdose and standard-dose or unspecified-dose CT. No studies had high methodological quality as evaluated by the QUADAS-2 tool. Major methodological problems were poor reference standards and partial verification primarily due to inadequate and incomplete follow-up in persons who did not have surgery. Authors' conclusionsThe sensitivity and specificity of CT for diagnosing appendicitis in adults are high. Unenhanced standard-dose CT appears to have lower sensitivity than standard-dose CT with intravenous, rectal, or oral and intravenous contrast enhancement. Use of di erent types of contrast enhancement or no enhancement does not appear to a ect specificity. Di erences in sensitivity and specificity between low-dose and standard-dose CT appear to be negligible. The results of this review should be interpreted with caution for two reasons. First, these results are based on studies of low methodological quality. Second, the comparisons between types of contrast enhancement and radiation dose may be unreliable because they are based on indirect comparisons that may be confounded by other factors.How reliable are the results of the studies in this review? Among the included studies, th...

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Neutralvspositive oral contrast in diagnosing acute appendicitis with contrast-enhanced CT: sensitivity, specificity, reader confidence and interpretation time

Cited by 13 publications

References 25 publications

Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications

Delaying surgery to perform CT scans for suspected appendicitis decreases the rate of negative appendectomies without increasing the rate of perforation nor postoperative complications

Role of Computed Tomography in Diagnosis of Appendicitis and Its Complications

Computed tomography for diagnosis of acute appendicitis in adults

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