Unfortunately, studies of radiological techniques in acute appendicitis have been marred by the lack of standardized radiological or even histological criteria for the diagnosis of appendicitis. There are also methodological limitations, including comparison of imaging with initial clinical assessments, lack of blinding, failure to confirm (either by surgery or by thorough and prolonged follow-up) the […]

The timely diagnosis of acute appendicitis is still mainly determined by the clinical acumen of attending physicians and surgeons. Diagnostic algorithms — including scoring systems, leukocyte counts and radiological imaging — may have adjunctive roles. Patients with classical clinical presentations should be operated on urgently, without resorting to prior imaging, unless complications that might affect […]

The MRI diagnosis of acute appendicitis is generally based on the demonstration of an abnormal appendix. The presence of periappendiceal fluid collections, appendiceal phlegmon, pericecal inflammatory changes or abscesses (with or without visualization of an inflamed appendix) signifies perforation. The appendix is often curved, and thus may be seen as two round structures on a […]

A newer technique involves in vivo targeting of leukocytes by a specific antileukocyte antibody (anti-CD15 immunoglobulin M monoclonal antibody, or LeuTech [Palatin Technologies, USA) that is labelled with 99mtechnetium. Thus, no preparatory time is required. Furthermore, most positive images are apparent within 15 min. The two published trials of this technique came from the same […]

Nuclear imaging techniques detect accumulations of white blood cells (or of immunoglobulins) in areas of inflammation. Other causes of RLQ inflammation are also detected, not all of which require surgery. Disease in atypical locations can be detected but may be misdiagnosed. Because the liver, spleen, bone marrow and large blood vessels take up radionuclide, the […]

Several groups have evaluated the cost effectiveness of CT scanning. The results of such an analysis depend on the relative costs of the test itself, hospital admission, surgery and care of patients with complications, and may not be easily translated across jurisdictions. Garcia Pena et al undertook a decision analysis based on a retrospective review […]

Many of the methodological deficiencies that have been described in ultrasonography studies also apply to CT studies. For example, strict histological criteria have not been employed, not all patients underwent surgery, CT was compared with initial (and not later) clinical assessment and most studies were carried out by a relatively small number of enthusiastic radiologists. […]

Accuracy in evaluating the appendix can be enhanced if 5 mm instead of 10 mm sections are taken during scanning — a procedure known as thin collimation. Scanning times can be reduced by narrowing the field to the area of the appendix alone. This technique, called focused appendiceal CT (FACT), may, however, miss disease elsewhere […]

Some of the criteria for the diagnosis of appendicitis with the use of CT are similar to those for diagnosis with the use of ultrasonography, including appendiceal dilation, wall thickening and appendicolithiasis. Periappendiceal changes are more readily identified by CT and include blurred pericecal fat, mesenteric fat stranding, phlegmon, abscess, abnormal collections of air and […]

Colour Doppler ultrasonography identifies areas of hypervascularity in the wall of the inflamed (but not the normal) appendix and in the wall of a periappendiceal abscess, and may be helpful if the appendix has a diameter of 5 to 7 mm. The absence of either a visible appendix or strong Doppler signals is said to […]