Radiology, Vol 180, 21-24, Copyright © 1991 by Radiological Society of North America

ARTICLES

Appendicitis: prospective evaluation with high-resolution CT

EJ Balthazar, AJ Megibow, SE Siegel and BA Birnbaum

Computed tomography (CT) was used to prospectively evaluate 100 patients with clinical indications for acute appendicitis. Examinations were performed with the terminal ileum and cecum filled with contrast material. Acute appendicitis was diagnosed when an abnormal appendix or inflammatory changes plus an appendicolith were detected. Failure to visualize an abnormal appendix or appendicolith in the presence of pericecal inflammatory changes was considered suspicious but nonspecific. CT results were correlated with surgical and pathologic results (74 patients) and other radiologic and clinical findings (26 patients). CT helped to diagnose appendicitis (64 patients) and nonspecific right lower quadrant inflammation (five patients) and to rule out appendicitis (31 patients). CT had a 98% sensitivity, an 83% specificity, and a 93% accuracy. In 17 of 31 patients without CT evidence of appendicitis, other conditions explaining their symptoms were detected. When the clinical diagnosis is in doubt, CT can be used successfully to evaluate patients with acute appendicitis.

This article has been cited by other articles:

				J B Andre, V A Sebastian, R M Ruchman, and S A Saad CT and appendicitis: evaluation of correlation between CT diagnosis and pathological diagnosis Postgrad. Med. J., June 1, 2008; 84(992): 321 - 324. [Abstract] [Full Text] [PDF]

				T. Moteki and H. Horikoshi New CT Criterion for Acute Appendicitis: Maximum Depth of Intraluminal Appendiceal Fluid Am. J. Roentgenol., May 1, 2007; 188(5): 1313 - 1319. [Abstract] [Full Text] [PDF]

				D. S. Katz, V. Merunka, J. J. Hines, E. M. Meiner, I. Pedrosa, D. Levine, and N. M. Rofsky Invited Commentary * Authors' Response RadioGraphics, May 1, 2007; 27(3): 743 - 753. [Full Text] [PDF]

				E M Anderson and H K Bungay Imaging investigation of acute right iliac fossa pain Imaging, December 1, 2006; 18(4): 257 - 267. [Abstract] [Full Text] [PDF]

				N. Pinto Leite, J. M. Pereira, R. Cunha, P. Pinto, and C. Sirlin CT Evaluation of Appendicitis and Its Complications: Imaging Techniques and Key Diagnostic Findings Am. J. Roentgenol., August 1, 2005; 185(2): 406 - 417. [Abstract] [Full Text] [PDF]

				C. P. Daly, R. H. Cohan, I. R. Francis, E. M. Caoili, J. H. Ellis, and B. Nan Incidence of Acute Appendicitis in Patients with Equivocal CT Findings Am. J. Roentgenol., June 1, 2005; 184(6): 1813 - 1820. [Abstract] [Full Text] [PDF]

				C. D. Levine, O. Aizenstein, O. Lehavi, and A. Blachar Why We Miss the Diagnosis of Appendicitis on Abdominal CT: Evaluation of Imaging Features of Appendicitis Incorrectly Diagnosed on CT Am. J. Roentgenol., March 1, 2005; 184(3): 855 - 859. [Abstract] [Full Text] [PDF]

				A. J. Hansen, S. W. Young, G. De Petris, D. J. Tessier, J. L. Hernandez, and D. J. Johnson Histologic Severity of Appendicitis Can Be Predicted by Computed Tomography Arch Surg, December 1, 2004; 139(12): 1304 - 1308. [Abstract] [Full Text] [PDF]

				T. Terasawa, C. C. Blackmore, S. Bent, and R. J. Kohlwes Systematic Review: Computed Tomography and Ultrasonography To Detect Acute Appendicitis in Adults and Adolescents Ann Intern Med, October 5, 2004; 141(7): 537 - 546. [Abstract] [Full Text] [PDF]

				P. Nikolaidis, C. M. Hwang, F. H. Miller, and N. Papanicolaou The Nonvisualized Appendix: Incidence of Acute Appendicitis When Secondary Inflammatory Changes Are Absent Am. J. Roentgenol., October 1, 2004; 183(4): 889 - 892. [Abstract] [Full Text] [PDF]

				M. M. Ziegler The Diagnosis of Appendicitis: An Evolving Paradigm Pediatrics, January 1, 2004; 113(1): 130 - 132. [Full Text] [PDF]

				L. Neumayer and A. Kennedy Imaging in Appendicitis: A Review With Special Emphasis on the Treatment of Women Obstet. Gynecol., December 1, 2003; 102(6): 1404 - 1409. [Abstract] [Full Text] [PDF]

				B. Siewert, V. Raptopoulos, S.-I. Liu, R. A. Hodin, R. B. Davis, and M. P. Rosen CT Predictors of Failed Laparoscopic Appendectomy Radiology, November 1, 2003; 229(2): 415 - 420. [Abstract] [Full Text] [PDF]

				P. Poortman, P. N. M. Lohle, C. M. C. Schoemaker, H. J. M. Oostvogel, H. J. L. J. M. Teepen, K. A. H. Zwinderman, and J. F. Hamming Comparison of CT and Sonography in the Diagnosis of Acute Appendicitis: A Blinded Prospective Study Am. J. Roentgenol., November 1, 2003; 181(5): 1355 - 1359. [Abstract] [Full Text] [PDF]

				E. Carney, J. Kempf, V. DeCarvalho, A. Yudd, and J. Nosher Preliminary Interpretations of After-Hours CT and Sonography by Radiology Residents Versus Final Interpretations by Body Imaging Radiologists at a Level 1 Trauma Center Am. J. Roentgenol., August 1, 2003; 181(2): 367 - 373. [Abstract] [Full Text] [PDF]

				M. M. Horrow, D. S. White, and J. C. Horrow Differentiation of Perforated from Nonperforated Appendicitis at CT Radiology, April 1, 2003; 227(1): 46 - 51. [Abstract] [Full Text] [PDF]

				V. Raptopoulos, G. Katsou, M. P. Rosen, B. Siewert, S. N. Goldberg, and J. B. Kruskal Acute Appendicitis: Effect of Increased Use of CT on Selecting Patients Earlier Radiology, February 1, 2003; 226(2): 521 - 526. [Abstract] [Full Text] [PDF]

				B. M. G. Pena, G. A. Taylor, S. J. Fishman, and K. D. Mandl Effect of an Imaging Protocol on Clinical Outcomes Among Pediatric Patients With Appendicitis Pediatrics, December 1, 2002; 110(6): 1088 - 1093. [Abstract] [Full Text] [PDF]

				S. E. Bendeck, M. Nino-Murcia, G. J. Berry, and R. B. Jeffrey Jr Imaging for Suspected Appendicitis: Negative Appendectomy and Perforation Rates Radiology, October 1, 2002; 225(1): 131 - 136. [Abstract] [Full Text] [PDF]

				T. T. Hui, K. M. Major, I. Avital, J. R. Hiatt, and D. R. Margulies Outcome of Elderly Patients With Appendicitis: Effect of Computed Tomography and Laparoscopy Arch Surg, September 1, 2002; 137(9): 995 - 1000. [Abstract] [Full Text] [PDF]

				G Ege, H Akman, A Sahin, D Bugra, and K Kuzucu Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis Br. J. Radiol., September 1, 2002; 75(897): 721 - 725. [Abstract] [Full Text] [PDF]

				T C See, C S Ng, C J E Watson, and A K Dixon Appendicitis: spectrum of appearances on helical CT Br. J. Radiol., September 1, 2002; 75(897): 775 - 781. [Abstract] [Full Text] [PDF]

				S. S. Raman, D. S. K. Lu, B. M. Kadell, D. J. Vodopich, J. Sayre, and H. Cryer Accuracy of Nonfocused Helical CT for the Diagnosis of Acute Appendicitis: A 5-Year Review Am. J. Roentgenol., June 1, 2002; 178(6): 1319 - 1325. [Abstract] [Full Text] [PDF]

				J.-H. Lee, Y. K. Jeong, J. C. Hwang, S. Y. Ham, and S.-O. Yang Graded Compression Sonography with Adjuvant Use of a Posterior Manual Compression Technique in the Sonographic Diagnosis of Acute Appendicitis Am. J. Roentgenol., April 1, 2002; 178(4): 863 - 868. [Abstract] [Full Text] [PDF]

				J. E. Jacobs, B. A. Birnbaum, M. Macari, A. J. Megibow, G. Israel, D. D. Maki, A. M. Aguiar, and C. P. Langlotz Acute Appendicitis: Comparison of Helical CT Diagnosis—Focused Technique with Oral Contrast Material versus Nonfocused Technique with Oral and Intravenous Contrast Material Radiology, September 1, 2001; 220(3): 683 - 690. [Abstract] [Full Text] [PDF]

				N. R. Fefferman, K. J. Roche, L. P. Pinkney, M. M. Ambrosino, and N. B. Genieser Suspected Appendicitis in Children: Focused CT Technique for Evaluation Radiology, September 1, 2001; 220(3): 691 - 695. [Abstract] [Full Text] [PDF]

				T. Rettenbacher, A. Hollerweger, P. Macheiner, L. Rettenbacher, F. Tomaselli, B. Schneider, and N. Gritzmann Outer Diameter of the Vermiform Appendix as a Sign of Acute Appendicitis: Evaluation at US Radiology, March 1, 2001; 218(3): 757 - 762. [Abstract] [Full Text]

				D. E. Grayson, J. R. Wettlaufer, N. C. Dalrymple, and C. A. Keesling Appendiceal CT in Pediatric Patients: Relationship of Visualization to Amount of Peritoneal Fat Am. J. Roentgenol., February 1, 2001; 176(2): 497 - 500. [Abstract] [Full Text] [PDF]

				J. H. Harris Jr Reflections: Emergency Radiology Radiology, February 1, 2001; 218(2): 309 - 316. [Abstract] [Full Text]

				L. H. Lowe, M. W. Penney, S. M. Stein, R. M. Heller, W. W. Neblett, Y. Shyr, and M. Hernanz-Schulman Unenhanced Limited CT of the Abdomen in the Diagnosis of Appendicitis in Children: Comparison with Sonography Am. J. Roentgenol., January 1, 2001; 176(1): 31 - 35. [Abstract] [Full Text]

				M. E. Mullins, M. F. Kircher, D. P. Ryan, D. Doody, T. C. Mullins, J. T. Rhea, and R. A. Novelline Evaluation of Suspected Appendicitis in Children Using Limited Helical CT and Colonic Contrast Material Am. J. Roentgenol., January 1, 2001; 176(1): 37 - 41. [Abstract] [Full Text]

				C. D Douglas, N. E Macpherson, P. M Davidson, and J. S Gani Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score BMJ, October 14, 2000; 321(7266): 919 - 919. [Abstract] [Full Text]

				I. R. Kamel, S. N. Goldberg, M. T. Keogan, M. P. Rosen, and V. Raptopoulos Right Lower Quadrant Pain and Suspected Appendicitis: Nonfocused Appendiceal CT-Review of 100 Cases Radiology, October 1, 2000; 217(1): 159 - 163. [Abstract] [Full Text]

				B. M. Garcia Peña, G. A. Taylor, S. J. Fishman, and K. D. Mandl Costs and Effectiveness of Ultrasonography and Limited Computed Tomography for Diagnosing Appendicitis in Children Pediatrics, October 1, 2000; 106(4): 672 - 676. [Abstract] [Full Text]

				P. M. Rao, M. J. Lane, and D. S. Katz Nonenhanced CT for Suspected Appendicitis Dr Lane and colleagues respond: Radiology, September 1, 2000; 216(3): 916 - 916. [Full Text]

				M. E. O'Malley, E. Halpern, P. R. Mueller, and G. S. Gazelle Helical CT Protocols for the Abdomen and Pelvis: A Survey Am. J. Roentgenol., July 1, 2000; 175(1): 109 - 113. [Abstract] [Full Text] [PDF]

				D. I. Weltman, J. Yu, J. Krumenacker Jr, S. Huang, and P. Moh Diagnosis of Acute Appendicitis: Comparison of 5- and 10-mm CT Sections in the Same Patient Radiology, July 1, 2000; 216(1): 172 - 177. [Abstract] [Full Text]

				B. A. Birnbaum and S. R. Wilson Appendicitis at the Millennium Radiology, May 1, 2000; 215(2): 337 - 348. [Abstract] [Full Text]

				B. A. Urban and E. K. Fishman Tailored Helical CT Evaluation of Acute Abdomen : (CME available in print version and on RSNA Link) RadioGraphics, May 1, 2000; 20(3): 725 - 749. [Abstract] [Full Text] [PDF]

				M. J. Lane, D. M. Liu, M. D. Huynh, R. B. Jeffrey Jr, R. E. Mindelzun, and D. S. Katz Suspected Acute Appendicitis: Nonenhanced Helical CT in 300 Consecutive Patients Radiology, November 1, 1999; 213(2): 341 - 346. [Abstract] [Full Text]

				B. M. G. Pena, K. D. Mandl, S. J. Kraus, A. C. Fischer, G. R. Fleisher, D. P. Lund, and G. A. Taylor Ultrasonography and Limited Computed Tomography in the Diagnosis and Management of Appendicitis in Children JAMA, September 15, 1999; 282(11): 1041 - 1046. [Abstract] [Full Text] [PDF]

				B. M. G. Pena, G. A. Taylor, D. P. Lund, and K. D. Mandl Effect of Computed Tomography on Patient Management and Costs in Children With Suspected Appendicitis Pediatrics, September 1, 1999; 104(3): 440 - 446. [Abstract] [Full Text] [PDF]

				P. M. Rao, J. T. Rhea, R. A. Novelline, A. A. Mostafavi, and C. J. McCabe Effect of Computed Tomography of the Appendix on Treatment of Patients and Use of Hospital Resources N. Engl. J. Med., January 15, 1998; 338(3): 141 - 146. [Abstract] [Full Text] [PDF]

				I. McColl More Precision in Diagnosing Appendicitis N. Engl. J. Med., January 15, 1998; 338(3): 190 - 191. [Full Text]

				R. Wijetunga, B. S. Tan, J. C. Rouse, G. W. Bigg-Wither, and B. D. Doust Diagnostic Accuracy of Focused Appendiceal CT in Clinically Equivocal Cases of Acute Appendicitis Radiology, December 1, 2001; 221(3): 747 - 753. [Abstract] [Full Text] [PDF]

				L. H. Lowe, K. S. Draud, M. Hernanz-Schulman, M. R. Newton, R. M. Heller, S. M. Stein, and T. Speroff Nonenhanced Limited CT in Children Suspected of Having Appendicitis: Prospective Comparison of Attending and Resident Interpretations Radiology, December 1, 2001; 221(3): 755 - 759. [Abstract] [Full Text] [PDF]