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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
Summary
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.