The use of advanced imaging for appendicitis in children

Abstract

Improved resolution of late-generation CT and US technology has fostered an increased reliance on imaging for the preoperative diagnosis or exclusion of appendicitis. Both modalities have been shown to have a high accuracy rate, but certain diagnostic challenges persist. CT has largely replaced US for the diagnosis of appendicitis in adults, but the modality of choice is less clear in children. US is usually more easily and rapidly performed in young patients, obviating the need for contrast administration and sedation. Ionizing radiation exposure is avoided with US. Assessment of physical signs and symptoms can be achieved while performing US, an advantage over CT. However, US is best interpreted during performance of the examination, and thus CT is often favored when the interpreter is in a remote location. Strategies using limited CT to follow an indeterminate US show high diagnostic accuracy. This article discusses the controversy surrounding the optimal imaging approach to acute abdominal pain in children and illustrates some of the challenges encountered with US and CT for the evaluation of appendicitis.