Is acute appendicitis complicated or uncomplicated? Approaching the question via computed tomography

Area of Science:

• Radiology
• Surgical Pathology
• Medical Imaging

Background:

• Accurate differentiation between complicated and uncomplicated appendicitis is crucial for appropriate treatment selection.
• Appendicitis diagnosis relies on clinical evaluation, laboratory tests, and imaging modalities.

Purpose of the Study:

• To evaluate the diagnostic performance of computed tomography (CT) in distinguishing complicated from uncomplicated appendicitis.
• To assess the potential of CT findings to reduce false-negative diagnoses when integrated into clinical assessment.

Main Methods:

• Retrospective analysis of 283 adult patients who underwent appendectomy and pre-operative CT scans.
• Patients were categorized into complicated and uncomplicated appendicitis groups based on pathological results.
• Evaluation of demographic data, laboratory results, and CT imaging features, including peri-appendiceal fat stranding (PFS) and appendix wall enhancement defect (AWD).

Main Results:

• Complicated appendicitis was associated with significantly higher mean patient age (P<0.001).
• Moderate to severe PFS and AWD were the most frequent CT findings in complicated appendicitis.
• Highest sensitivity findings were PFS (77.9%) and AWD (69.4%); abscess, phlegmon, and peri-appendiceal air showed 100% specificity but low sensitivity.
• A CT-based scoring system achieved a sensitivity of 83.3% and a specificity of 79.2% for complicated appendicitis.

Conclusions:

• CT imaging provides valuable information for differentiating appendicitis types.
• The developed CT scoring system demonstrates potential utility in the differential diagnosis of complicated appendicitis, improving diagnostic accuracy.