Retrospective Study
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World J Gastroenterol. Oct 14, 2014; 20(38): 13942-13949
Published online Oct 14, 2014. doi: 10.3748/wjg.v20.i38.13942
Stratified computed tomography findings improve diagnostic accuracy for appendicitis
Geon Park, Sang Chul Lee, Byung-Jo Choi, Say-June Kim
Geon Park, Department of Radiology, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 301-723, South Korea
Sang Chul Lee, Byung-Jo Choi, Say-June Kim, Department of Surgery, Daejeon St. Mary’s Hospital, The Catholic University of Korea, Daejeon 301-723, South Korea
Author contributions: Kim SJ designed the study and approved the final manuscript; Lee SC and Choi BJ collected and analyzed the data; and Park G wrote the paper.
Correspondence to: Say-June Kim, MD, PhD, Department of Surgery, Daejeon St. Mary’s Hospital, The Catholic University of Korea, 520-2 Daeheung-dong, Joong-gu, Daejeon 301-723, South Korea. sejoonkim@hanmail.net
Telephone: +82-42-2209520 Fax: +82-42-2209565
Received: April 11, 2014
Revised: June 12, 2014
Accepted: July 11, 2014
Published online: October 14, 2014
Abstract

AIM: To improve the diagnostic accuracy in patients with symptoms and signs of appendicitis, but without confirmative computed tomography (CT) findings.

METHODS: We retrospectively reviewed the database of 224 patients who had been operated on for the suspicion of appendicitis, but whose CT findings were negative or equivocal for appendicitis. The patient population was divided into two groups: a pathologically proven appendicitis group (n = 177) and a non-appendicitis group (n = 47). The CT images of these patients were re-evaluated according to the characteristic CT features as described in the literature. The re-evaluations and baseline characteristics of the two groups were compared.

RESULTS: The two groups showed significant differences with respect to appendiceal diameter, and the presence of periappendiceal fat stranding and intraluminal air in the appendix. A larger proportion of patients in the appendicitis group showed distended appendices larger than 6.0 mm (66.3% vs 37.0%; P < 0.001), periappendiceal fat stranding (34.1% vs 8.9%; P = 0.001), and the absence of intraluminal air (67.6% vs 48.9%; P = 0.024) compared to the non-appendicitis group. Furthermore, the presence of two or more of these factors increased the odds ratio to 6.8 times higher than baseline (95%CI: 3.013-15.454; P < 0.001).

CONCLUSION: Appendiceal diameter and wall thickening, fat stranding, and absence of intraluminal air can be used to increased diagnostic accuracy for appendicitis with equivocal CT findings.

Keywords: Appendectomy, Appendicitis, Computed tomography, Diagnostic accuracy, Re-evaluation

Core tip: When equivocal computed tomography (CT) findings for appendicitis are encountered, the diagnostic accuracy can be enhanced by identifying several characteristic CT features: appendiceal diameter ≥ 6.0 mm, appendiceal wall thickening ≥ 2.0 mm, periappendiceal fat stranding, and the absence of intraluminal air. Therefore, radiologists, surgeons and physicians should apply these criteria when encountering patients with equivocal CT findings for appendicitis.