The Role of Radiological Imaging in the Diagnosis of Acute Appendicitis

Abstract

Several strategies have been employed to improve the accuracy of the diagnosis of appendicitis and to reduce the associated perforation rate. Because clinical algorithms have been disappointing, many physicians resort to radiological modalities. Plain abdominal x-rays are nonspecific, barium enema examination has relatively low accuracy, scintigraphy scans require considerable time and are difficult to interpret, and magnetic resonance imaging is relatively unstudied. The most promising modalities are graded compression sonography and computed tomography. In expert hands, these techniques can achieve a high degree of accuracy. Nevertheless, most published studies have been marred by methodological difficulties. Moreover, ultrasound is more useful in detecting than in ruling out appendicitis. The radiological criteria for acute appendicitis, the accuracy of various imaging modalities and the limitations of the available research are described.

Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis

“…Early diagnosis is crucial to the success of therapy [1,2,21]. Currently, CT is being used for differential diagnosis of acute abdomen such as appendicitis, especially in patients with undetermined and inconclusive ultrasound findings.…”

Acute appendicitis in preschool-age children

“…Acute appendicitis is the most common surgical emergency in childhood, constituting 1%-2% of all children admitted to the paediatric emergency ward [1,2,3]. Those with the typical symptoms and signs of acute appendicitis or suspected cases with definite findings of peritonitis are promptly indicated for surgery.…”

“…Once the appendix ruptures, which is very common in preschool-age children with appendicitis, the ultrasound findings disappear and are replaced by peritoneal fluid and thickened bowel loops, and the diagnostic accuracy is reduced. Although many reports of appendicitis among school-age children have been published, few investigators have focused on the diagnostic difficulties of diagnosing appendicitis in preschool age children [1,6,7,8,9,10,11]. We analysed retrospectively our experience of emergency appendectomies in patients below 5 years of age over an 11-year period.…”

White Cell Count and C-Reactive Protein Measurement in Patients with Possible Appendicitis

“…1 The diagnosis of acute appendicitis relies largely on clinical assessment, although both ultrasound and computed tomography (CT) can be helpful. 2,3 Over the years, many studies have looked at various simple blood tests and clinical criteria in an attempt to improve diagnostic accuracy. The white cell count (WCC) and C-reactive protein (CRP) are now often used to guide clinical assessment but past studies have demonstrated sensitivities of CRP measurements ranging from 40% to 94%, and specificities of 38-87%.…”