Prognostic CT-imaging findings for complicated acute appendicitis: A prospective cohort study

Area of Science:

• Radiology
• Surgical Pathology

Background:

• Computed tomography (CT) is crucial for diagnosing appendicitis severity.
• Accurate differentiation between uncomplicated and complicated appendicitis is vital for treatment selection.
• Antibiotic therapy is a viable alternative for uncomplicated appendicitis.

Purpose of the Study:

• To identify computed tomography (CT) factors that predict complicated acute appendicitis.
• To evaluate the association between appendiceal diameter and appendicitis severity.
• To assess the prognostic value of appendiceal wall enhancement and surrounding fluid/edema on CT.

Main Methods:

• Prospective cohort study of 3085 patients with CT-diagnosed appendicitis.
• Analysis of CT variables including appendiceal diameter, wall enhancement defect, and periappendiceal fluid/edema.
• Subgroup analysis of 1965 patients without an appendicolith.

Main Results:

• Wider appendiceal diameter and appendiceal wall enhancement defect on CT are significantly associated with complicated appendicitis (p < 0.001).
• Appendiceal wall enhancement defect showed an odds ratio of 3.39 for complicated appendicitis in patients without an appendicolith.
• No definitive cutoff for appendiceal diameter predicting complicated appendicitis was identified.

Conclusions:

• CT findings of increased appendiceal diameter and wall enhancement defects are reliable indicators of complicated appendicitis risk.
• These objective imaging markers aid clinicians in treatment decisions, including suitability for non-operative management.
• Recognizing these CT prognostic factors is essential for optimizing patient care pathways.