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Appendiceal diameter: CT versus sonographic measurements.

Emily S Orscheln1, Andrew T Trout2

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Summary

The 6 mm diameter cutoff for diagnosing pediatric appendicitis is unreliable as CT scans measure larger than ultrasound (US). Appendiceal diameter measurements differ by 1-2 mm between CT and US, impacting diagnostic accuracy.

Keywords:
AppendicitisAppendixChildrenComputed tomographyDiameterUltrasound

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Area of Science:

  • Pediatric Radiology
  • Diagnostic Imaging
  • Gastrointestinal Imaging

Background:

  • Ultrasound (US) and CT are primary tools for pediatric appendicitis diagnosis.
  • Appendiceal diameter is a key diagnostic criterion for both modalities.
  • A 6 mm diameter cutoff is traditionally used for appendicitis diagnosis via US and CT.

Purpose of the Study:

  • To evaluate the validity of using a single 6 mm diameter cutoff for diagnosing appendicitis in children.
  • To compare appendiceal diameter measurements obtained via US and CT.
  • To highlight discrepancies in appendiceal diameter measurements between imaging modalities.

Main Methods:

  • Retrospective review of pediatric patients (<18 years) who underwent both US and CT of the appendix within 24 hours.
  • Measurement of the shortest transverse appendiceal dimension at proximal, mid, and distal locations.
  • Paired t-test used to compare mean absolute differences in appendiceal diameter between US and CT.

Main Results:

  • 155 children were included; 24.5% were diagnosed with appendicitis.
  • CT measurements of appendiceal diameter were significantly larger than US measurements in both normal (5.3 vs. 4.7 mm) and appendicitis cases (8.3 vs. 7.0 mm).
  • Mean absolute diameter difference ranged from 1.3-1.4 mm for normal appendices and 2 mm for appendicitis.

Conclusions:

  • Appendiceal diameter measurements show a consistent 1-2 mm difference between US and CT.
  • The current 6 mm cutoff for appendicitis diagnosis is questionable due to modality-specific measurement variations.
  • Future diagnostic criteria should account for the differences in appendiceal diameter measurements between US and CT.