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New CT Criterion for Acute Appendicitis: Maximum Depth of Intraluminal Appendiceal Fluid

Takao Moteki1 and Hiroyuki Horikoshi2

1 Department of Radiology, Fujioka General Hospital, 942-1 Fujioka, Fujiokashi, Gunma 375-8503, Japan.
2 Department of Radiology, Gunma Cancer Tomo Hospital, Gunma, Japan.


Figure 1
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  		Fig. 1 —34-year-old woman with appendicitis without periappendiceal inflammation (surgically proven appendicitis case in appendicitis group). Contrast-enhanced CT image at cecal level reveals that this appendicitis case (arrow) satisfies only two CT criteria for appendicitis: maximum appendiceal diameter greater than 6 mm and maximum depth of intraluminal appendiceal fluid greater than 2.6 mm.

 

Figure 2
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  		Fig. 2 —46-year-old man with rectal cancer and normal appendix (a case in noncomplicated-normal-appendix group). Contrast-enhanced CT scan at cecal level shows no significant intraluminal appendiceal fluid (arrow) despite satisfying some CT criteria for appendicitis: maximum appendiceal diameter greater than 6 mm, maximum appendiceal wall thickness greater than 3 mm, and presence of appendiceal wall enhancement (arrowhead).

 

Figure 3
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  		Fig. 3 —44-year-old man with normal appendix with complication of enteritis (a case in complicated-normal-appendix group). Contrast-enhanced CT scan at cecal level shows no significant intraluminal appendiceal fluid despite satisfying some CT criteria for appendicitis: maximum appendiceal diameter greater than 6 mm, maximum appendiceal wall thickness greater than 3 mm (arrow), and presence of focal cecal wall thickening (arrowhead).

 

Figure 4
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  		Fig. 4 —82-year-old man with normal appendix with complication of enteritis (a case in complicated-normal-appendix group). Contrast-enhanced CT scan at cecal level shows fluid collection in appendix (maximum depth of intraluminal appendiceal fluid greater than 2.6 mm) (arrow), presence of appendiceal wall enhancement, and maximum appendiceal diameter greater than 6 mm. In addition, large fluid collection in cecum (28 mm in depth) (arrowheads) is also seen. This intraluminal appendiceal fluid collection may be caused by hydrostatic pressure of prominent intraluminal fluid of cecum.

 

Figure 5
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  		Fig. 5A —Receiver operating characteristic curves for wall thickness and intraluminal fluid. Graphs compare maximum appendiceal wall thickness (solid lines) and maximum depth of intraluminal appendiceal fluid (dashed lines) of appendicitis group versus noncomplicated-normal-appendix group (A) and of appendicitis group versus complicated-normal-appendix group (B).

 

Figure 6
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  		Fig. 5B —Receiver operating characteristic curves for wall thickness and intraluminal fluid. Graphs compare maximum appendiceal wall thickness (solid lines) and maximum depth of intraluminal appendiceal fluid (dashed lines) of appendicitis group versus noncomplicated-normal-appendix group (A) and of appendicitis group versus complicated-normal-appendix group (B).

 

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