II. Indications
- Suspected Appendicitis
III. Technique
- Focused below lower pole of right Kidney
-
CT Abdomen with IV contrast alone is sufficient in most cases
- Similar efficacy in Appendicitis diagnosis with IV contrast alone when compared with IV and Oral Contrast
- Oral Contrast may be indicated in thin patients (without adequate fatty tissue) or when abscess is suspected
- Drake (2014) Ann Surg 260(2):311-6 [PubMed]
IV. Interpretation: Signs suggestive of Appendicitis
- Fat streaking
- Appendix exceeds 6 mm in diameter
- Fluid filled peripheral enhancing tubular structure
- RLQ inflammation and no normal appendix identified
- Appendix wall thickening
V. Efficacy
- CT Abdomen is considered the preferred first-line study in evaluation of suspected Appendicitis
- Helical CT most accurate
- Test Sensitivity: >87%
- Test Specificity: >95%
- Accuracy: 93-98%
- Negative Predictive Value: 95%
- Fefferman (2001) Radiology 220:691-5 [PubMed]
- CT does not seem to improve diagnosis of Appendicitis
- Study finds that CT overall did not offer benefit
- Also CT prolonged emergency room and hospital stays
- CT with contrast may provide better accuracy
- Perez (2003) Am J Surg 185:194-7 [PubMed]