Unenhanced helical CT for suspected acute appendicitis.

Lane, Michael J.; Katz, Douglas S.; Ross, Barry; Clautice-Engle, T; Mindelzun, R E; Jeffrey, R. Brooke

doi:10.2214/ajr.168.2.9016216

Cited by 226 publications

(108 citation statements)

References 20 publications

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“…Overall negative appendectomy rate (8.6%) of the present study is similar to rates reported in the relevant literature (6,7). Although intravenous iodinated contrast agents may have serious side effects and CT scan itself is costly, CT may provide evidence of early stage of appendicitis and its complications (8). Non-contrast-enhanced, thin-section CT is faster and safer alternative to enhanced CT scan, and is preferred as standard technique at our institution.…”

Section: Discussionsupporting

confidence: 88%

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Evaluation of Clinical and Imaging Findings in Children with Diagnosis of Acute Appendicitis

et al. 2017

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Objectives: This study is an evaluation of the accuracy of ultrasonography (USG), computed tomography (CT), and Alvarado score (AS) in the diagnosis and management of acute appendicitis in children. Methods: Records of pediatric patients admitted to the pediatric emergency department (ED) between 2008 and 2012 were evaluated retrospectively. Patient data from the national electronic health information system was screened and those with complete clinical and imaging findings (AS, preoperative USG and/or CT images) and postoperative pathological diagnosis were included in the study. Results: Study group consisted of 449 children with diagnosis of suspected acute appendicitis aged between 3 and 15 years (mean age: 9.20 ± 2.73 years). Of the total, 428 (95.3%) patients underwent appendectomy and 21 (4.7%) cases were treated conservatively. Mean duration of symptoms was 4.94 ± 1.84 hours. Pathological evaluation results were negative (i.e., removal of normal appendix) in 36 (8.4%) patients; histopathological diagnosis was acute appendicitis in 392 (91.6%) patients. Perforated appendix was found in 38 (8.5%) patients. In patients with histopathologically confirmed appendicitis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CT in diagnosis of acute appendicitis were 96.3%, 55.6%, 92.8%, and 71.4%, respectively. Sensitivity, specificity, PPV, and NPV of USG were 73.5%, 22.2%, 91.1%, and 69.2%, respectively. Negative appendectomy rate was 6.4% (n = 8) in patients who had preoperative CT scan, and 6.5% (n = 28) in patients who had USG examination. Conclusions: CT has higher sensitivity than USG in diagnosis of acute appendicitis. USG, on the other hand, is widely accessible method and does not use ionizing radiation. Therefore, it may be used as initial radiological imaging method in acute appendicitis. Thin-filter, contrast-unenhanced CT scans may be preferred in cases where clinical signs and USG findings are unclear or controversial.

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Section: Discussionsupporting

confidence: 88%

“…In the present study, specificity of CT was 93.4% in patients with AS of between 5 and 7 and 100% in patients with AS of 8 with positive CT finding and histopathological confirmation had significantly higher AS. In a systematic review con- (19,20).…”

Section: Discussionsupporting

confidence: 48%

Evaluation of Clinical and Imaging Findings in Children with Diagnosis of Acute Appendicitis

et al. 2017

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“…The presence of an appendicolith per se is not considered diagnostic for acute appendicitis in the absence of pericecal inflammatory changes or appendiceal wall enhancement. 2-13% of asymptomatic individuals have appendicolith on routine abdominal CT [32] [33]. Of all the CT signs of acute appendicitis, the presence of appendicolith has been reported to have 100% specificity but low sensitivity (44%) [34].…”

Section: Contrast Enhanced Computerised Tomography [Cect]mentioning

confidence: 99%

Dropped Appendicolith: Complications and Management

Yethadka

Kl³

2015

Int Jour of Biomed Res

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Appendicitis is one of the most common acute abdomen presenting to emergency department and appendicectomy is the commonest emergency laparotomy performed worldwide. Laparoscopic appendicectomy is gaining popularty nowadays due to its advantageous over open procedure. But the complications such as postoperative abscess formation are more common with laparoscopic approach, the culprit being dropped appendicolith in most cases. This review explains about the presentation of dropped appendicolith, complications, prevention and the management of the same.

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“…As such, another well-studied protocol is unenhanced CT without the use of oral or IV contrast [28][29][30][31][32][33][34][35][36] in both pediatric 28,30,33,35 and adult populations where the reported sensitivity and specificity of diagnosing appendicitis ranges from 87-96% and 91-98% respectively 31,32,35 . With non-contrast CT, the patient's intra-abdominal fat provides enough "natural" contrast to visualize the appendix by accentuating periappendiceal inflammatory change, which facilitates the diagnosis of acute appendicitis.…”

Section: Diagnostic Radiologymentioning

confidence: 99%