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Diagnostic performance of multidetector CT for suspected acute appendicitis

This week's issue of the Annals of Internal Medicine evaluates diagnostic performance of multidetector computed tomography for suspected acute appendicitis.

News image

Use of preoperative computed tomography for suspected acute appendicitis has dramatically increased since the introduction of multidetector computed tomography (CT) scanners.

Dr Perry Pickhardt and colleagues from Wisconsin, USA evaluated the diagnostic performance of multidetector CT for suspected acute appendicitis in adults.

The team analyzed multidetector CT findings, and clinical outcomes of 2871 consecutive adults referred for multidetector CT for suspected appendicitis from 2000 to 2009.

Interpretation of nonfocused abdominopelvic multidetector CT scans by radiologists who were aware of the study indication.
24% of patients had confirmed acute appendicitis
Annals of Internal Medicine

Posttest assessment of diagnostic performance of multidetector CT for acute appendicitis, according to the reference standard of final combined clinical, surgical, and pathology findings.

The research team found that 24% of patients had confirmed acute appendicitis.

The sensitivity, specificity, and negative and positive predictive values of multidetector CT were 99%, 98%, 99.5%, and 94%, respectively.

Positive and negative likelihood ratios were 51 and 0.02, respectively.

The resarchers observed that the overall rate of negative findings at appendectomy was 8%, but would have decreased to 4% had surgery been avoided in 26 cases with true-negative findings on multidetector CT.

The team noted that overall perforation rate was 18% but progressively decreased from 29% in 2000 to 12% in 2009.

Multidetector computed tomography provided or suggested an alternative diagnosis in 42% of patients without appendicitis or appendectomy.

Dr Pickhardt and colleagues commented, "Multidetector computed tomography is a useful test for routine evaluation of suspected appendicitis in adults."

Ann Int Med 2011: 154(12): 789-796
24 June 2011

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