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1
Department of Radiology, Pennsylvania State University College of Medicine,
Milton S. Hershey Medical Center, 500 University Dr., Hershey, PA 17033.
2
116 Racehorse Dr., Jonestown, PA 17038.
3
Department of Emergency Medicine, Pennsylvania State University College of
Medicine, Hershey, PA 17033.
4
Department of Pathology, Pennsylvania State University College of Medicine,
Hershey, PA 17033.
5
Department of Health Evaluation Sciences, Pennsylvania State University
College of Medicine, Hershey, PA 17033.
OBJECTIVE. We performed a comparative assessment of CT and sonographic techniques used to assess appendicitis.
MATERIALS AND METHODS. One hundred patients with clinically suspected acute appendicitis were examined with sonography, unenhanced focused appendiceal CT, complete abdominopelvic CT using IV contrast material, focused appendiceal CT with colonic contrast material, and repeated sonography with colonic contrast material. Each sonogram was videotaped for subsequent interpretation by three radiologists and two sonographers. The mean sensitivity, specificity, positive and negative predictive values, inter- and intraobserver variability, and diagnostic confidence scores of all observers were used for comparative performance assessments. The three CT examinations were filmed and interpreted separately by four radiologists. Patient discomfort was assessed on a 10-point scale for each radiologic study. Diagnoses were confirmed by pathologic evaluation of resected appendixes or clinical follow-up for a minimum of 3 months after presentation.
RESULTS. Twenty-four of the 100 patients had positive findings for
acute appendicitis. Both sonographic techniques had high specificity (85-89%)
and comparable accuracy (73-75%) but low sensitivity (33-35%) and inter- and
intraobserver variability (
= 0.15-0.20 and 0.39-0.42, respectively).
Unenhanced focused appendiceal CT, abdominopelvic CT, and focused appendiceal
CT with colonic contrast material all significantly outperformed sonography
(p <0.0001), with sensitivities of 78%, 72%, and 80%;
specificities of 86%, 91%, and 87%; and accuracies of 84%, 87%, and 85%,
respectively. Abdominopelvic CT gave the greatest confidence in cases with
negative findings (p = 0.001), and focused appendiceal CT with
colonic contrast material gave the greatest confidence for cases with positive
findings (p = 0.02). In terms of inter- and intraobserver
variability, focused appendiceal CT with colonic contrast material yielded the
highest, and unenhanced focused appendiceal CT the lowest, agreement
(interobserver = 0.45 vs. 0.36 and intraobserver = 0.85 vs.
0.76, respectively) (p <0.05). Colonic contrast material was
unsuccessfully advanced into the cecum in 18% of patients and leaked in
another 24%. Patient discomfort was greatest with focused appendiceal CT using
colonic contrast material and least with unenhanced focused appendiceal CT
(p <0.05).
CONCLUSION. A standard abdominopelvic CT scan is recommended as the initial examination for appendicitis in adult patients. However, focused appendiceal CT with colonic contrast material material should be used as a problem-solving technique in difficult cases.
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