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Acute Appendicitis: Comparison of Helical CT Diagnosis—Focused Technique with Oral Contrast Material versus Nonfocused Technique with Oral and Intravenous Contrast Material¹

¹ From the Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104 (J.E.J., B.A.B., D.D.M., A.M.A., C.P.L.); and Department of Radiology, New York University Medical Center, New York, NY (M.M., A.J.M., G.I.). From the 2000 RSNA scientific assembly. Received September 14, 2000; revision requested November 3; final revision received February 13, 2001; accepted February 26. Address correspondence to J.E.J. (e-mail: jacobs@rad.upenn.edu).

View larger version (99K): [in a new window]   Figure 1a. CT scans in a 21-year-old man with acute onset right lower quadrant abdominal pain. (a) Nonenhanced transverse CT scan shows the appendix as a nonspecific soft-tissue mass (black arrow) located anterior to the lumbosacral junction. The borders of the appendix are difficult to discern because of minimal retroperitoneal fat and the proximity of the adjacent right external and internal iliac vessels (white arrow). (b) Contrast-enhanced transverse CT scan shows the inflamed appendix (black arrow), located medial to the enhanced iliac vessels (white arrow). The appendix is readily identifiable by its abnormally thickened and enhanced wall. No periappendiceal inflammatory change is present.

View larger version (101K): [in a new window]   Figure 1b. CT scans in a 21-year-old man with acute onset right lower quadrant abdominal pain. (a) Nonenhanced transverse CT scan shows the appendix as a nonspecific soft-tissue mass (black arrow) located anterior to the lumbosacral junction. The borders of the appendix are difficult to discern because of minimal retroperitoneal fat and the proximity of the adjacent right external and internal iliac vessels (white arrow). (b) Contrast-enhanced transverse CT scan shows the inflamed appendix (black arrow), located medial to the enhanced iliac vessels (white arrow). The appendix is readily identifiable by its abnormally thickened and enhanced wall. No periappendiceal inflammatory change is present.

View larger version (117K): [in a new window]   Figure 2a. CT scans in a 21-year-old man with nausea and abdominal pain, which were suggestive of acute appendicitis. (a) Nonenhanced transverse CT scan shows the inflamed appendix (arrow) in cross section. The appendix is easily identified because of the presence of abundant retroperitoneal fat and well-opacified adjacent small-bowel loops. Periappendiceal inflammation was absent. (b) Contrast-enhanced transverse CT scan shows abnormal mural thickening and enhancement of the slightly dilated, inflamed appendix (arrow).

View larger version (122K): [in a new window]   Figure 2b. CT scans in a 21-year-old man with nausea and abdominal pain, which were suggestive of acute appendicitis. (a) Nonenhanced transverse CT scan shows the inflamed appendix (arrow) in cross section. The appendix is easily identified because of the presence of abundant retroperitoneal fat and well-opacified adjacent small-bowel loops. Periappendiceal inflammation was absent. (b) Contrast-enhanced transverse CT scan shows abnormal mural thickening and enhancement of the slightly dilated, inflamed appendix (arrow).

View larger version (34K): [in a new window]   Figure 3. Areas under the ROC curves of readers with focused nonenhanced CT. The area under the ROC curve for reader 1 () was 0.951 ± 0.025, that for reader 2 () was 0.902 ± 0.029, and that for reader 3 () was 0.901 ± 0.035. FPF = false-positive fraction, TPF = true-positive fraction.

View larger version (32K): [in a new window]   Figure 4. Areas under the ROC curves of readers with nonfocused enhanced CT. The area under the ROC curve for reader 1 () was 0.954 ± 0.024, that for reader 2 () was 0.985 ± 0.017, and that for reader 3 () was 0.954 ± 0.024. FPF = false-positive fraction, TPF = true-positive fraction.

View larger version (121K): [in a new window]   Figure 5a. CT scans in a 29-year-old woman with acute appendicitis. (a, b) Nonenhanced transverse CT scans show the inflamed appendix (arrows) lying within the right lower quadrant. The appendix is enlarged, but no periappendiceal inflammatory soft-tissue stranding is apparent. (c, d) Contrast-enhanced transverse CT scans show a mural stratification enhancement pattern within the thickened appendiceal wall (arrows), a sign that is diagnostic of the presence of inflammation.

View larger version (120K): [in a new window]   Figure 5b. CT scans in a 29-year-old woman with acute appendicitis. (a, b) Nonenhanced transverse CT scans show the inflamed appendix (arrows) lying within the right lower quadrant. The appendix is enlarged, but no periappendiceal inflammatory soft-tissue stranding is apparent. (c, d) Contrast-enhanced transverse CT scans show a mural stratification enhancement pattern within the thickened appendiceal wall (arrows), a sign that is diagnostic of the presence of inflammation.

View larger version (130K): [in a new window]   Figure 5c. CT scans in a 29-year-old woman with acute appendicitis. (a, b) Nonenhanced transverse CT scans show the inflamed appendix (arrows) lying within the right lower quadrant. The appendix is enlarged, but no periappendiceal inflammatory soft-tissue stranding is apparent. (c, d) Contrast-enhanced transverse CT scans show a mural stratification enhancement pattern within the thickened appendiceal wall (arrows), a sign that is diagnostic of the presence of inflammation.

View larger version (136K): [in a new window]   Figure 5d. CT scans in a 29-year-old woman with acute appendicitis. (a, b) Nonenhanced transverse CT scans show the inflamed appendix (arrows) lying within the right lower quadrant. The appendix is enlarged, but no periappendiceal inflammatory soft-tissue stranding is apparent. (c, d) Contrast-enhanced transverse CT scans show a mural stratification enhancement pattern within the thickened appendiceal wall (arrows), a sign that is diagnostic of the presence of inflammation.