| The Role of Computed Tomography in the Diagnosis of Acute Appendicitis. |
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Choi, In Seok , Yea, Byung Kook , Han, Gun Taek , Sim, Mun Sup |
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Department of Surgery, Pusan National University Hospital, Busan, Korea. gsdoctor@chollian.net |
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| Abstract |
PURPOSE
Appendicitis represents one of the most common surgical disorders. Typically, the diagnosis can be made from well established clinical criteria, with an acceptable negative appendectomy rate from 7~25%. However, when surgical intervention is performed in the patients suspected of having appendicitis but with equivocal clinical findings, the negative appendectomy rate approaches 50%. Routine contrast-enhanced computed tomography (CECT) has described as an accurate diagnostic imaging modality in patients with suspected appendicitis. We evaluated the role of intravenous CECT (iCECT) in patients suspected of having appendicitis but with equivocal clinical exams.
METHODS
Eighty seven consecutive patients who were thought to have appendicitis but with equivocal clinical findings and/or physical exams were imaged by iCECT over 18 months period. Intravenous contrast-enhanced, spiral abdominal and pelvic images were obtained using 7.5 mm cuts. iCECT images were interpreted by a board-certified radiologist. Main outcome measures included iCECT sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accurary and negative appendectomy rate in the diagnosis of acute appendicitis, and determining the impact iCECT on the clinical management of the patient population.
RESULTS
A group of 87 patients consisting of 36 males (41.4 %) and 51 females (58.6%) with median age of 32 years (range 12 to 75 years) were imaged with iCECT to evaluate suspected appendicitis. Of the 87 iCECTs performed, 8 false-positive and 2 false-negative readings were identified, resulting in a sensitivity of 93.5%, specificity of 85.7%, PPV of 78.4%, NPV of 96%, and an overall accuracy of 88.5%. With regard to clinical management, 100% (31/31) of patients with appendicitis, and 4% (2/50) of patients without appendicitis underwent appendectomy. Therefore, the overall negative appendectomy rate was 6.1% (2/33).
CONCLUSION
iCECT is a useful diagnostic imaging modality for patients suspected of having acute appendicitis but with equivocal clinical findings and/or physical exams. iCECT is particularly useful in excluding the diagnosis of appendicitis in those without disease. |
| Key Words:
Acute appendicitis; Computed tomography |
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