MDCT Highly Accurate in Spotting Acute Appendecitis

The dramatic increases in the use of Multidetector CT scanners (MDCT) prior to surgery in cases of acute appendicitis appear justified by their diagnostic abilities, a new study suggests.

Lead author Perry J. Pickhardt and colleagues at the University of Wisconsin School of Medicine and Public Health in Madison reviewed the medical records of 2,871 adults who had been admitted for possible appendicitis from 2000 to 2009, 675 (23.5 percent) of whom indeed had acute appendicitis based on clinical, surgical, and pathology findings. The study was published June 2 in the Annals of Internal Medicine.

The MDCT had accurately identified acute appendicitis with a sensitivity of 98.5 percent and specificity of 98 percent. The overall rate of negative findings at appendectomy was 7.5%, but would have decreased to 4.1 percent had surgery been avoided in 26 cases with true-negative findings on MDCT, the authors reported.

Overall, 17.8 percent of patients were found to have ruptured appendixes, a figure that fell from 28.9 percent in 2000 to 11.5 percent in 2009, a slide which the authors noted corresponded with the ramp-up in MDCT use at their medical center. What’s more, Pickhardt and colleagues said MDCT suggested alternative diagnoses in 42.1 percent of the patients whose scans indicated a problem other than appendicitis.

Appendicitis remains remain the most common cause for emergency abdominal surgery. U.S. preoperative CT use leaped 70 percent in the five years beginning in 2002.

Source: Pickhardt P, et al "Diagnostic performance of multidetector computed tomography for suspected acute appendicitis" Ann Intern Med 2011; 154: 789-796.