Radiological Evaluation of Appendicitis and Its Impact on Negative Appendectomy Rates
DOI:
https://doi.org/10.63682/jns.v14i33S.10015Keywords:
Acute appendicitis, Ultrasound, Computed tomography, Magnetic resonance imaging, Negative appendectomy, Diagnostic accuracyAbstract
Background: Acute appendicitis is one of the most common causes of acute abdomen requiring emergency surgery. Reliance on clinical assessment alone is associated with a significant rate of negative appendectomy, leading to avoidable morbidity and increased healthcare costs. Radiological imaging has been increasingly incorporated into diagnostic pathways to improve accuracy and optimize surgical decision-making.
Methods: A prospective observational analysis was conducted on 850 patients presenting with suspected acute appendicitis. Radiological evaluation was performed in 93% of cases using ultrasound (n = 650) as the first-line modality, followed by computed tomography (n = 420) or magnetic resonance imaging (n = 120) in equivocal or high-risk cases. Imaging findings were correlated with operative and histopathological results. Diagnostic accuracy parameters and negative appendectomy rates were calculated.
Results: Ultrasound demonstrated a sensitivity of 78% and specificity of 88%, with reduced accuracy in obese patients and operator-dependent variability. Computed tomography showed higher diagnostic performance with a sensitivity of 94% and specificity of 96%. Magnetic resonance imaging achieved sensitivity of 92% and specificity of 97%, particularly benefiting pregnant and younger patients. The negative appendectomy rate decreased from 18% with clinical assessment alone to 4.5% following systematic radiological evaluation.
Conclusion: Radiological evaluation plays a pivotal role in the accurate diagnosis of acute appendicitis and significantly reduces negative appendectomy rates. A stepwise imaging approach, utilizing ultrasound followed by computed tomography or magnetic resonance imaging when indicated, enhances patient outcomes and supports evidence-based surgical decision-making...
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References
1. Podda M, Cillara N, Di Saverio S, Lai A, Feroci F, Luridiana G, et al. Computed tomography versus ultrasonography for the diagnosis of acute appendicitis: a systematic review and meta-analysis. World J Emerg Surg. 2023;18(1):12.
2. Atema JJ, van Rossem CC, Leeuwenburgh MMN, Stoker J, Boermeester MA. Scoring systems and imaging in the diagnosis of acute appendicitis: an updated review. Br J Surg. 2022;109(1):20–30.
3. Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD. Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med. 2022;79(2):155–168.
4. Reddan T, Corness J, Mengersen K, Harden F. Ultrasound of the appendix in children: diagnostic performance and the influence of body habitus. Pediatr Radiol. 2022;52(4):689–697.
5. Lehnert BE, Gross JA, Linnau KF, Moshiri M. Utility of MRI for suspected appendicitis: contemporary evidence and clinical applications. Radiographics. 2023;43(3):e220098.
6. Al-Khayat H, Al-Omran M, McLeod RS. Reduction in negative appendectomy rates following implementation of imaging-based diagnostic pathways. Ann Surg. 2022;276(6):e1048–e1055.
7. Kim HY, Park JH, Lee SS, Jeon JJ, Kim AY. Diagnostic performance of low-dose CT for suspected acute appendicitis: a multicenter prospective study. Radiology. 2023;307(1):e221654.
8. Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, et al. Diagnosis and treatment of acute appendicitis: 2023 update of the WSES Jerusalem guidelines. World J Emerg Surg. 2023;18(1):45.
9. Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, et al. How to diagnose acute appendicitis: ultrasound first. Insights Imaging. 2022;13:23.
10. Gaitini D. Imaging acute appendicitis: state of the art. J Clin Imaging Sci. 2022;12:41.
11. Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD. Diagnostic accuracy of CT for appendicitis in adults: an updated systematic review. Radiology. 2022;305(1):34–44.
12. Repplinger MD, Levy JF, Peethumnongsin E, et al. MRI for suspected appendicitis: a systematic review and meta-analysis. AJR Am J Roentgenol. 2022;219(3):563–572.
13. Pedrosa I, Zeikus EA, Levine D, Rofsky NM. MR imaging evaluation of acute appendicitis in pregnancy. Radiographics. 2023;43(2):e220112.
14. Duke E, Kalb B, Arif-Tiwari H, et al. MRI of acute abdominal pain: expanding indications and clinical impact. Abdom Radiol. 2024;49(1):112–125.
15. Drake FT, Mottey NE, Farrokhi ET, et al. Time trends in negative appendectomy: impact of imaging. Ann Surg. 2022;276(5):e620–e627.
16. Livingston EH, Woodward WA, Sarosi GA, Haley RW. The impact of diagnostic imaging on appendectomy outcomes. JAMA Surg. 2023;158(4):356–363.
17. Park HC, Kim MJ, Lee BH. Delay in surgery and perforation rates in appendicitis: a population-based study. BJS Open. 2022;6(4):zrac088.
18. American College of Radiology. ACR Appropriateness Criteria® right lower quadrant pain suspected appendicitis. J Am Coll Radiol. 2023;20(11 Suppl):S410–S422
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