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Imaging strategies in children with suspected appendicitis

Karen Rosendahl1, Stein Magnus Aukland, Kari Fosse

  • 1Department of Pediatric Radiology, Haukeland University Hospital, 5021 Bergen, Norway. karen.rosendahl@helse-bergen.no

European Radiology
|January 31, 2004
PubMed

Insights

Pediatric appendicitis diagnosis benefits from imaging. Ultrasound (US) is the first choice, with computed tomography (CT) used as a supplementary tool to improve accuracy in diagnosing appendicitis in children.

Area of Science:

  • Pediatric Surgery
  • Diagnostic Imaging
  • Emergency Medicine

Background:

  • Appendicitis is a common pediatric surgical emergency, often presenting with atypical symptoms, particularly in younger children, leading to delayed diagnosis.
  • Clinical assessment alone for appendicitis in children has limitations, with accuracy ranging from 70-90% and a significant rate of normal appendectomies (13-25%).

Purpose of the Study:

  • To review and compare the accuracy of various imaging modalities for diagnosing acute appendicitis in children.
  • To determine the optimal imaging strategy for suspected pediatric appendicitis.

Main Methods:

  • Extensive literature review of studies evaluating imaging techniques for acute appendicitis in pediatric populations.
  • Analysis of reported sensitivity and specificity for Ultrasound (US) and helical Computed Tomography (CT) scans.
  • Inclusion of findings from a randomized study comparing US alone versus US combined with CT.

Main Results:

  • Preoperative imaging significantly reduces the normal appendectomy rate to 3-7% without increasing perforation rates.
  • Helical CT shows higher sensitivity (95-97%) than US (87-95%), while both have comparable specificity (US: 85-98%, CT: 94-97%).
  • A combination of US and CT increased sensitivity to 99% but slightly decreased specificity to 89% compared to US alone.

Conclusions:

  • Imaging is recommended for all children with suspected appendicitis.
  • Ultrasound (US) should be the initial imaging modality.
  • Computed Tomography (CT) serves as a valuable complementary tool when US is inconclusive or to further enhance diagnostic accuracy.

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