The role of radiological imaging in the diagnosis of acute appendicitis: COLOUR DOPPLER SONOGRAPHY Part 1
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 be strong evidence against the diagnosis of acute appendicitis. Doppler signals may not be detectable, however, if gangrenous appendicitis supervenes. This technique can also reveal other inflammatory and even neoplastic conditions in the abdomen and pelvis, some of which can cause false-positive results on conventional (gray scale) ultrasonography scans. Doppler ultrasonography is slightly more accurate than conventional techniques, although the differences may not be clinically significant. A further refinement, power Doppler sonography, may more precisely evaluate local blood flow, but some authorities question its benefit.
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The past decade has witnessed the increasing use of CT in the assessment of patients with acute appendicitis. Advantages of CT over ultrasonography include enhanced ability to detect the normal appendix (and thus rule out the diagnosis of appendicitis), appendicoliths (especially when using helical CT), retrocecal appendicitis, perforation and its complications, and alternative diagnoses. Disadvantages are the increased cost of CT; the use of ionizing radiation; the frequent need for contrast material; and the time required to prepare the patient, and to perform and interpret the scan. Unlike ultrasonography, CT is more effective for obese patients. Overall, the diagnostic accuracy of CT is superior to that of ultrasonography, and CT is often able to establish the diagnosis when sonography is inconclusive. Radiologists generally have more confidence in CT, and surgeons are more likely to trust a negative CT than a negative ultrasonography result. There is less dependence on operator technique, and the images are more easily interpreted by trainees, by radiologists without special training and even by clinicians.