Sensitivity and Specificity of the Individual CT Signs of Appendicitis: Experience with 200 Helical Appendiceal CT Examinations

Rao, Patrick M.; Rhea, James T.; Novelline, Robert A.

doi:10.1097/00004728-199709000-00002

Cited by 209 publications

(142 citation statements)

References 14 publications

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“…The following signs, commonly related to appendicitis or absence of appendicitis in standard CT [30,31], were recorded for each LDCT and reported on a standardized form: 1. appendicolith; 2. appendix diameter-an appendix was reported enlarged when its diameter was at least 7 mm because this value was considered an optimal balance between sensitivity and specificity of the CT [5]; 3. gas in the appendiceal lumen; 4. caecal wall thickening (localized thickening of the caecal wall at the origin of the appendix); 5. periappendiceal fat stranding, with or without confluence (phlegmon); 6. pericaecal abscess; 7. arrowhead sign (arrowhead-shaped collection of contrast media localized to the upper portion of the caecum, near the root of the appendix) [31]; 8. contrast media in the appendiceal lumen; 9. free fluid in the lower-right paracolic gutter or Douglas' pouch.…”

Section: Data Collection and Analysismentioning

confidence: 99%

Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis

et al. 2008

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The aim of this study was to evaluate a low-dose CT with oral contrast medium (LDCT) for the diagnosis of acute appendicitis and compare its performance with standard-dose i.v. contrast-enhanced CT (standard CT) according to patients' BMIs. Eighty-six consecutive patients admitted with suspicion of acute appendicitis underwent LDCT (30 mAs), followed by standard CT (180 mAs). Both examinations were reviewed by two experienced radiologists for direct and indirect signs of appendicitis. Clinical and surgical follow-up was considered as the reference standard. Appendicitis was confirmed by surgery in 37 (43%) of the 86 patients. Twenty-nine (34%) patients eventually had an alternative discharge diagnosis to explain their abdominal pain. Clinical and biological follow-up was uneventful in 20 (23%) patients. LDCT and standard CT had the same sensitivity (100%, 33/33) and specificity (98%, 45/46) to diagnose appendicitis in patients with a body mass index (BMI) ≥ 18.5. In slim patients (BMI < 18.5), sensitivity to diagnose appendicitis was 50% (2/4) for LDCT and 100% (4/4) for standard CT, while specificity was identical for both techniques (67%, 2/3). LDCT may play a role in the diagnostic workup of patients with a BMI ≥ 18.5.

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Section: Data Collection and Analysismentioning

confidence: 99%

Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis

et al. 2008

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“…High diagnostic performance of pelvicand appendiceal-focused CT has been reported for acute appendicitis [2,[8][9][10][11][12][13], but only two studies have compared appendiceal-focused CT with scans on the entire abdomen and pelvis [2,13]. However, these studies used various administration protocols involving intravenous (IV) and enteric contrast material, preventing us generalising their results.…”

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confidence: 99%

Optimisedz-axis coverage at multidetector-row CT in adults suspected of acute appendicitis

Brassart

Winant²,

Tack³

et al. 2013

BJR

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Objective: To compare diagnostic performances of two reduced z-axis coverages to full coverage of the abdomen and pelvis for the diagnosis of acute appendicitis and alternative diseases at unenhanced CT. Methods: This study included 152 adults suspected of appendicitis who were enrolled in two ethical committeeapproved previous prospective trials. Based on scans covering the entire abdomen and pelvis (set L), two additional sets of images were generated, each with reduced z-axis coverages: (1) from the top of the iliac crests to the pubis (set S) and (2) from the diaphragmatic crus to the pubis (set M). Two readers independently coded the visualisation of the appendix, measured its diameter and proposed a diagnosis (appendicitis or alternative). Final diagnosis was based on surgical findings or clinical follow-up. Fisher exact and McNemar tests and logistic regression were used.Results: 46 patients had a definite diagnosis of appendicitis and 53 of alternative diseases. The frequency of appendix visualisation was lower for set S than set L for both readers (89% and 84% vs 95% and 91% by Readers A and B, respectively; p50.021 and 0.022). The probability of giving a correct diagnosis was lower for set S (68%) than set L (78%; odds ratio, 0.611; p50.008) for both readers, without significant difference between sets L and M (77%, p50.771); z-axis coverage being reduced by 25% for set M. Conclusion: Coverage from diaphragmatic crus to pubis, but not focused on pelvis only, can be recommended in adults suspected of appendicitis. Advances in knowledge: In suspected appendicitis, CT-coverage can be reduced from diaphragmatic crus to pubis.

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“…Anyhow patient became OK after the operation and we have two points about this case. The first one appendicitis could be diagnosed as gastroenteritis and gastroenteritis could be diagnosed as appendicitis or atypical appendicitis, CT scan may cannot determine the gastroenteritis or appendicitis even if appendix diameter more than 6 mm may be the size has increase by inflammatory process (10,11,12). The second point which better for sever ill patient under diagnoses or over diagnosis, we prefer the proper diagnosis but in critically ill patient you should be safe your patient.…”

Section: Discussionmentioning

confidence: 99%

Gastroenteritis Versus Appendicitis: A Case Study on Light of Clinical Assessment, Diagnostic CT Scan and Evidence Based Practice

Elrobaa¹,

Hamad²,

Ahmad³

et al. 2018

IAM

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Physicians who wait for clear, easily recognizable signs will miss many diagnoses. The Gastroenteritis is one of the most common medical emergencies in emergency department (ED). The Appendicitis continues to be the most common acute surgical emergency. The diagnosis of early appendicitis continues to be a challenge for the emergency physician. There is a differential diagnosis between gastroenteritis and appendicitis. The presentation of loose motion or diarrhea cannot be rule out appendicitis alone its need a global of clinical assessment, investigation and imaging (1). In this case we will discuss a case which presented as gastroenteritis, then diagnosed by CT scan as appendicitis but the surgeon and histopathological report diagnosed it back Gastroenteritis.

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Sensitivity and Specificity of the Individual CT Signs of Appendicitis: Experience with 200 Helical Appendiceal CT Examinations

Cited by 209 publications

References 14 publications

Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis

Evaluation of a low-dose CT protocol with oral contrast for assessment of acute appendicitis

Optimisedz-axis coverage at multidetector-row CT in adults suspected of acute appendicitis

Gastroenteritis Versus Appendicitis: A Case Study on Light of Clinical Assessment, Diagnostic CT Scan and Evidence Based Practice

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