Imaging acute appendicitis: state of the art

Area of Science:

• Radiology
• Gastroenterology
• Emergency Medicine

Background:

• Acute appendicitis remains a common surgical emergency.
• Accurate and timely diagnosis is crucial to prevent complications.
• Imaging plays a pivotal role in diagnosing appendicitis, guiding clinical management.

Purpose of the Study:

• To review the current state of imaging modalities for diagnosing acute appendicitis.
• To evaluate the performance, advantages, and disadvantages of different imaging techniques.
• To provide guidance on selecting appropriate imaging strategies in various clinical scenarios.

Main Methods:

• Comprehensive literature search of MEDLINE database (last five years, humans, English).
• Inclusion of core clinical journals and manual reference list checking.
• Review focused on performance metrics and clinical utility of imaging tests.

Main Results:

• Ultrasound (US) is recommended as the initial imaging modality, particularly for pediatric, young adult, and pregnant populations.
• A positive US or a negative US with low clinical suspicion can lead to a definitive diagnosis.
• In cases of negative or indeterminate US with high clinical suspicion, CT or MRI (in pregnant patients) are indicated.

Conclusions:

• US is the preferred first-line imaging test for suspected acute appendicitis.
• CT and MRI serve as valuable secondary or alternative diagnostic tools when US is inconclusive.
• Imaging selection should be tailored to patient demographics and clinical presentation for optimal diagnostic yield.