Dr Pascal Gervaz

Chirurgien FMH, chirurgie interne & chirurgie viscérale

 

 

Acute Appendicitis: Prospective Evaluation of a Diagnostic Algorithm Integrating Sonography, Low-dose CT and Standard CT

 

 

by Pierre-Alexandre Poletti, Alexandra Platon, Thomas De Perrot, Francois Sarasin, Elisabeth Andereggen, Olivier Rutschmann, Elise Dupuis-Lozeron, Thomas Perneger, Pascal Gervaz, Christop D. Becker.

 

 

Objectives

To evaluate an algorithm integrating ultrasound and low-dose unenhanced CT with oral contrast medium (LDCT) in the assessment of acute appendicitis, to reduce the need of conventional CT.

 

Methods

Ultrasound was performed upon admission in 183 consecutive adult patients (111 women, 72 men, mean age 32) with suspicion of acute appendicitis and a BMI between 18.5 and 30 (step 1). No further examination was recommended when ultrasound was positive for appendicitis, negative with low clinical suspicion, or demonstrated an alternative diagnosis. All other patients underwent LDCT (30 mAs) (step 2). Standard intravenously enhanced CT (180 mAs) was performed after indeterminate LDCT (step 3).

 

Results

No further imaging was recommended after ultrasound in 84 (46%) patients; LDCT was obtained in 99 (54%). LDCT was positive or negative for appendicitis in 81 (82%) of these 99 patients, indeterminate in 18 (18%) who underwent standard CT. Eighty-six (47%) of the 183 patients had a surgically proven appendicitis. The sensitivity and specificity of the algorithm were 98.8% and 96.9%.

 

Conclusions

The proposed algorithm achieved high sensitivity and specificity for detection of acute appendicitis, while reducing the need for standard CT and thus limiting exposition to radiation and to intravenous contrast media.

 

 

in European Radiology 2011 Dec;21(12): 2558-66. doi: 10.1007/s 00330-011-2212-5. Epub 2011 Jul 30