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Differentiation of Perforated from Nonperforated Appendicitis at CT¹

¹ From the Department of Radiology, Albert Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA 19141 (M.M.H., D.S.W.); and Department of Anesthesiology, Drexel University College of Medicine, Philadelphia, Pa (J.C.H.). From the 2001 RSNA scientific assembly. Received March 7, 2002; revision requested April 26; final revision received July 19; accepted August 17. Address correspondence to M.M.H. (e-mail: horrowm@einstein.edu).

PURPOSE: To evaluate the sensitivity and specificity of five computed tomographic (CT) criteria in the differentiation of perforated from nonperforated appendicitis.

MATERIALS AND METHODS: CT scans of 94 patients with surgically proven appendicitis were classified on review as showing perforation if one of five CT findings was present. The authors calculated the sensitivity and specificity for each finding by comparing the predicted outcome to the surgical and pathologic outcome.

RESULTS: The perforated group comprised 39 patients and the nonperforated group comprised 55 patients. Sensitivity for abscess, phlegmon, extraluminal air, extraluminal appendicolith, and focal defect in enhancing appendiceal wall individually were 36%, 46%, 36%, 21%, and 64%, respectively. Sensitivity for any one of the five findings was 94.9%. Specificities were 100% for all findings except for phlegmon (95%). Groups differed with respect to age: 47 years ± 19 (mean ± SD) for perforated appendicitis and 30 years ± 13 for nonperforated appendicitis (P < .001). Groups also differed with respect to appendiceal diameter: 15 mm ± 4.9 for perforated appendicitis and 12 mm ± 3.3 for nonperforated appendicitis (P = .049).

CONCLUSION: A dedicated search for five specific CT findings allowed an overall sensitivity of 94.9% for perforated appendicitis. Among findings with 100% specificity, a focal defect in the enhancing appendiceal wall achieved the highest sensitivity.

© RSNA, 2003

Index terms: Appendicitis, 751.291 • Appendix, CT, 751.1211

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