CT of appendicitis

Balthazar, EJ; Megibow, Alec J.; Hulnick, Donald H.; Gordon, Richard B.; Naidich, David P.; Beranbaum, Elliott R.

doi:10.2214/ajr.147.4.705

Cited by 90 publications

(30 citation statements)

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“…Computed tomography of the abdomen and pelvis (CT-A/P) has become the diagnostic modality of choice for evaluation of acute right lower quadrant abdominal pain [1][2][3]. CT-A/P has become an important diagnostic tool to diagnose or exclude acute appendicitis, with a sensitivity and negative predictive value that surpasses compression sonography and clinical exam [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Choudhri

Carr

et al. 2011

J Digit Imaging

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Advances in handheld computing now allow review of DICOM datasets from remote locations. As the diagnostic ability of this tool is unproven, we evaluated the ability to diagnose acute appendicitis on abdominal CT using a mobile DICOM viewer. This HIPAA compliant study was IRB-approved. Twenty-five abdominal CT studies from patients with RLQ pain were interpreted on a handheld device (iPhone) using a DICOM viewer (OsiriX mobile) by five radiologists. All patients had surgical confirmation of acute appendicitis or follow-up confirming no acute appendicitis. Studies were evaluated for the ability to find the appendix, maximum appendiceal diameter, presence of an appendicolith, periappendiceal stranding and fluid, abscess, and an assessment of the diagnosis of acute appendicitis. Results were compared to PACS workstation. Fifteen cases of acute appendicitis were correctly identified on 98% of interpretations, with no false-positives. Eight appendicoliths were correctly identified on 88% of interpretations. Three abscesses were correctly identified by all readers. Handheld device measurement of appendiceal diameter had a mean 8.6% larger than PACS measurements (p=0.035). Evaluation for acute appendicitis on abdominal CT studies using a portable device DICOM viewer can be performed with good concordance to reads performed on PACS workstations.

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Section: Introductionmentioning

confidence: 99%

Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis

Choudhri

Carr

et al. 2011

J Digit Imaging

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“…13 His initial study of 60 patients reported ultrasound had a sensitivity of 89%, a specificity of 100% and an overall accuracy of 95%. Later that year, Balthazar and colleagues 14 reported results from a series of 38 patients with proven appendicitis, 30 of whom were accurately diagnosed on CT, resulting in a sensitivity of 79%. Over the next 20 years, dozens of studies evaluated various aspects of each of these modalities and their perceived benefits and shortcomings, but only a few were specific to children.…”

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confidence: 99%

Pediatric appendicitis: pathophysiology and appropriate use of diagnostic imaging

Brennan

2006

CJEM

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Evaluating children for appendicitis can be extremely difficult, and various strategies have been developed to improve the precision of preoperative diagnosis. Among these, ultrasound and computed tomography (CT) are now widely used but remain controversial. Although CT scanning is superior to ultrasound in terms of diagnostic accuracy for appendicitis, the large dose of ionizing radiation from CT and the risk of subsequent radiation-induced malignancy (RIM) are of particular concern in pediatric patients. This article reviews the literature on the pathophysiology, morbidity and mortality of appendicitis, summarizes the data regarding pediatric imaging in appendicitis, provides a practical approach to imaging for clinicians who evaluate pediatric patients, and makes recommendations for reducing the risk of RIM in pediatric patients. RÉSUMÉIl peut être extrêmement difficile d'évaluer les enfants pour diagnostiquer l'appendicite et diverses stratégies ont été mise au point pour améliorer la précision du diagnostic préopératoire. L'échographie et la tomodensitométrie (TDM), notamment, sont maintenant très répandues, mais elles demeurent controversées. Même si la TDM est supérieure à l'échographie pour ce qui est de l'exactitude du diagnostic d'appendicite, une dose importante de rayonnements ionisants provenant de l'appareil et le risque de tumeur maligne radio-induite (TMRI) subséquente préoc-cupe particulièrement chez les patients en pédiatrie. Dans cet article, les auteurs passent en revue les publications sur la pathophysiologie, la morbidité et la mortalité de l'appendicite, résument les données sur l'imagerie pédiatrique dans les cas d'appendicite, présentent une stratégie pratique d'imagerie pour les cliniciens qui évaluent des patients en pédiatrie et formulent des recommandations afin de réduire le risque de TMRI chez les patients en pédiatrie.

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“…The present study was done to evaluate the use of Modified Alvarado scoring system in reducing the number of negative appendicectomy and to evaluate the sensitivity of MASS in diagnosis of Acute Appendicitis.Our results and observations were discussed and compared with various studies. The age group in which acute appendicitis occurred commonly was between 12 and 30 years [10]. The result of present study showed that a high score (> 7) in men was a satisfactory aid in early diagnosis of acute appendicitis , the overall sensitivity in men with scores > 7 was 91.30% .…”

Section: Discussionmentioning

confidence: 48%