Low-dose noncontrast computed tomography in adults with acute appendicitis

Singh, Nongthombam Roshan; Luwang, Nongthombam Thomson; Priyabarta, Yumnam; Singh, Chabungbam Gyan; Singh, Wahengbam Jatishwar

doi:10.4103/jms.jms_35_17

Cited by 2 publications

(1 citation statement)

References 3 publications

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“…Rud et al found the probability of having AA following a positive CT result and after a negative CT result to be 0.92 and 0.04, respectively ( 6 ) N.R. Singh et al found the sensitivity and specificity of NCCT in the diagnosis of AA as 98.2% and 100%, respectively ( 20 ). A systematic review by Terasawa et al concluded that CT was more accurate for the diagnosis of AA than USG with an overall sensitivity of 0.94 and overall specificity of 0.95.…”

Section: Discussionmentioning

confidence: 99%

The Roles of USG and NCCT in the Diagnosis of Acute Appendicitis: A Study in a Tertiary Care Center in North Eastern India

Uddalok Das,

Amarendra Nath Sarkar,

Dilip Chandra Barman

et al. 2023

Ethiop J Health Sci

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BACKGROUND: Acute appendicitis is a common cause of hospital admission and emergency laparotomy among children and young adults. Although the diagnosis is clinical, the use of radiological imaging has emerged over the past decades. Its principal use is as a problem-solving tool in equivocal cases. Owing to the increased use of imaging in the last few years, the negative appendicectomy rate has dropped significantly. In this prospective observational study, we compared the diagnostic accuracy of Ultrasonography and Non-Contrast Computed Tomography. METHOD: One hundred and eighteen patients with clinically suspected appendicitis followed a designed protocol. Patients underwent appendicectomy after a first performed positive ultrasonography or after a positive Non-Contrast Computed Tomography when Ultrasonography was equivocal or nonspecific. When any other diagnosis was apparent in either imaging modality which could explain the symptomatology in the patient, they were considered negative for acute appendicitis and treated accordingly. RESULTS: The respective sensitivity, specificity, and accuracy for Ultrasonography, Non-Contrast Computed Tomography, and the whole diagnostic pathway for the diagnosis of acute appendicitis were 70.73%,80.83%, and 78.54; 100%,100%,100%, and 83.6%; and 100%,83.33% and 94.92%. CONCLUSION: Using Ultrasonography as the first-line diagnostic tool and Non-Contrast Computed Tomography as a complementary second-line diagnostic tool, appendicitis can be diagnosed with high accuracy and the negative laparotomy rate can be brought down significantly without any increase in the risk of complications. Computed Tomography is superior to Ultrasonography for the diagnosis of acute appendicitis.

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Section: Discussionmentioning

confidence: 99%

The Roles of USG and NCCT in the Diagnosis of Acute Appendicitis: A Study in a Tertiary Care Center in North Eastern India

Uddalok Das,

Amarendra Nath Sarkar,

Dilip Chandra Barman

et al. 2023

Ethiop J Health Sci

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Computed tomography for diagnosis of acute appendicitis in adults

Rud

Vejborg

Rappeport

et al. 2019

Cochrane Database of Systematic Reviews

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Cochrane Database of Systematic Reviews Data collection and analysisTwo review authors independently collected the data from each study and evaluated methodological quality according to the Quality Assessment of Studies of Diagnostic Accuracy -Revised (QUADAS-2) tool. We used the bivariate random-e ects model to obtain summary estimates of sensitivity and specificity. Main resultsWe identified 64 studies including 71 separate study populations with a total of 10,280 participants (4583 with and 5697 without acute appendicitis). Estimates of sensitivity ranged from 0.72 to 1.0 and estimates of specificity ranged from 0.5 to 1.0 across the 71 study populations. Summary sensitivity was 0.95 (95% confidence interval (CI) 0.93 to 0.96), and summary specificity was 0.94 (95% CI 0.92 to 0.95). At the median prevalence of appendicitis (0.43), the probability of having appendicitis following a positive CT result was 0.92 (95% CI 0.90 to 0.94), and the probability of having appendicitis following a negative CT result was 0.04 (95% CI 0.03 to 0.05). In subgroup analyses according to contrast enhancement, summary sensitivity was higher for CT with intravenous contrast (0.96, 95% CI 0.92 to 0.98), CT with rectal contrast (0.97, 95% CI 0.93 to 0.99), and CT with intravenous and oral contrast enhancement (0.96, 95% CI 0.93 to 0.98) than for unenhanced CT (0.91, 95% CI 0.87 to 0.93). Summary sensitivity of CT with oral contrast enhancement (0.89, 95% CI 0.81 to 0.94) and unenhanced CT was similar. Results show practically no di erences in summary specificity, which varied from 0.93 (95% CI 0.90 to 0.95) to 0.95 (95% CI 0.90 to 0.98) between subgroups. Summary sensitivity for low-dose CT (0.94, 95% 0.90 to 0.97) was similar to summary sensitivity for standard-dose or unspecified-dose CT (0.95, 95% 0.93 to 0.96); summary specificity did not di er between lowdose and standard-dose or unspecified-dose CT. No studies had high methodological quality as evaluated by the QUADAS-2 tool. Major methodological problems were poor reference standards and partial verification primarily due to inadequate and incomplete follow-up in persons who did not have surgery. Authors' conclusionsThe sensitivity and specificity of CT for diagnosing appendicitis in adults are high. Unenhanced standard-dose CT appears to have lower sensitivity than standard-dose CT with intravenous, rectal, or oral and intravenous contrast enhancement. Use of di erent types of contrast enhancement or no enhancement does not appear to a ect specificity. Di erences in sensitivity and specificity between low-dose and standard-dose CT appear to be negligible. The results of this review should be interpreted with caution for two reasons. First, these results are based on studies of low methodological quality. Second, the comparisons between types of contrast enhancement and radiation dose may be unreliable because they are based on indirect comparisons that may be confounded by other factors.How reliable are the results of the studies in this review? Among the included studies, th...

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Low-dose noncontrast computed tomography in adults with acute appendicitis

Cited by 2 publications

References 3 publications

The Roles of USG and NCCT in the Diagnosis of Acute Appendicitis: A Study in a Tertiary Care Center in North Eastern India

The Roles of USG and NCCT in the Diagnosis of Acute Appendicitis: A Study in a Tertiary Care Center in North Eastern India

Computed tomography for diagnosis of acute appendicitis in adults

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