Unenhanced spiral CT for evaluating acute appendicitis in daily routine. Aprospective study

Background/Aims: The purpose of this study was to define in a routine setti ng the role of spiral computed tomography in patients with suspected acute appendicitis and to determine the effect of computed tomography on the trea tment of such patients. Methodology: Appendiceal computed tomography was performed in 120 consecuti ve patients with acute appendicitis in the differential diagnosis, whose cl inical findings were insufficient to perform surgery or to discharge from t he hospital. Each scan was obtained in a single breath hold from the lower abdomen to the upper pelvis using a 5-mm collimation and a pitch of 1.6. Co mputed tomography results were correlated with surgical and pathologic find ings at appendectomy or clinical follow-up. Results: Eighty-eight of the 93 patients with acute appendicitis were corre ctly diagnosed by computed tomography, 24 of the 27 patients without acute appendicitis were correctly diagnosed by computed tomography (95% sensitivi ty, 89% specificity). Computed tomography signs of acute appendicitis inclu ded fat stranding (100%), enlarged appendix (>6mm) (97%), adenopathy (63%), appendicoliths (43%), abscess (10%), and phlegmon (5%). Conclusions: The use of spiral computed tomography in patients with equivoc al clinical presentation suspected of having acute appendicitis led to a si gnificant improvement in the preoperative diagnosis and a lower negative ap pendectomy rate. Appendiceal computed tomography is an accurate technique e ven if performed in the daily routine of scanning.