Does computed tomography have any additional value after sonography in patients with suspected acute appendicitis?

Area of Science:

• Radiology
• Medical Imaging
• Gastroenterology

Background:

• Acute appendicitis remains a common surgical emergency.
• Diagnostic imaging plays a crucial role in confirming appendicitis and guiding treatment.
• Sonography is often the initial imaging modality, but its effectiveness can be limited by patient factors and visualization of the appendix.

Purpose of the Study:

• To determine the added diagnostic value of computed tomography (CT) following initial sonography in patients with suspected acute appendicitis.
• To assess the impact of supplementary CT findings on clinical management decisions.

Main Methods:

• A retrospective review of 52 patients with suspected acute appendicitis who underwent both sonography and CT.
• Radiologists classified appendix findings as normal, equivocal appendicitis, nonperforated acute appendicitis, or perforated appendicitis.
• Head-to-head comparison of sonographic and CT results to evaluate the additional value of CT.

Main Results:

• No discrepancies were found between sonography and CT for normal appendices or definite appendicitis diagnoses.
• Computed tomography provided additional diagnostic value in 19.2% of cases (10 out of 52 patients).
• This additional information from CT influenced treatment decisions in only 5 patients.

Conclusions:

• Sonography is a reliable tool for diagnosing acute appendicitis when results are definitive.
• Supplementary CT should be reserved for cases where sonography is inconclusive to optimize resource utilization.
• The routine use of supplementary CT after sonography may not be necessary in all suspected appendicitis cases.