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Acute Appendicitis: Comparison of Low-Dose and Standard-Dose Unenhanced Multi–Detector Row CT¹

¹ From the Department of Radiology, Hôpital Erasme, Université Libre de Bruxelles, Route de Lennik 808, B-1070 Brussels, Belgium (C.K., P.B., P.A.G., D.V.G.); Department of Radiology, Centre Hospitalier Universitaire de Charleroi, Belgium (D.T.); and Statistical Unit, Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire, Université Libre de Bruxelles, Belgium (V.d.M.). Received July 16, 2003; revision requested September 29; final revision received December 29; accepted January 16, 2004. Address correspondence to C.K.

PURPOSE: To prospectively compare low- and standard-dose unenhanced multi–detector row computed tomography (CT) in patients suspected of having acute appendicitis.

MATERIALS AND METHODS: Ninety-five consecutive patients underwent two unenhanced multi–detector row CT examinations with 4 x 2.5-mm collimation, 120 kVp, and 30 and 100 effective mAs. Two radiologists independently read the images obtained at each dose during two sessions. Readers recorded visualization of the appendix and presence of gas in its lumen, appendicolith, periappendiceal fat stranding, cecal wall thickening, and abscess or phlegmon to measure the diameter of the appendix and to propose diagnosis (appendicitis or alternative). Data were compared according to dose and reader, with definite diagnosis established on basis of surgical findings (n = 37) or clinical follow-up. ² tests and logistic regression were used. Measurement agreements were assessed with Cohen statistics.

RESULTS: Twenty-nine patients had a definite diagnosis of appendicitis. No difference was observed between the frequency of visualization of the appendix (P = .874) neither in its mean diameter (P = .101–.696, according to readers and sessions) nor in the readers’ overall diagnosis (P = .788) at each dose. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of each sign were not different between doses. Fat stranding, appendicolith, and diameter were the most predictive signs, regardless of dose, yielding approximately 90% of correct diagnoses. The ability to propose a correct alternative diagnosis was not influenced by the dose.

CONCLUSION: Low-dose unenhanced multi–detector row CT has similar diagnostic performance as standard-dose unenhanced multi–detector row CT for the diagnosis of acute appendicitis.

© RSNA, 2004

Index terms: Appendicitis, 751.291 • Appendix, CT, 751.12111, 751.12117 • Computed tomography (CT), multi–detector row • Computed tomography (CT), radiation exposure

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