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Comparative Assessment of CT and Sonographic Techniques for Appendiceal Imaging

¹ Department of Radiology, Pennsylvania State University College of Medicine, Milton S. Hershey Medical Center, 500 University Dr., Hershey, PA 17033.
² 116 Racehorse Dr., Jonestown, PA 17038.
³ Department of Emergency Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033.
⁴ Department of Pathology, Pennsylvania State University College of Medicine, Hershey, PA 17033.
⁵ Department of Health Evaluation Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033.

View larger version (17K): [in a new window]   Fig. 1A. —Graphs show diagnostic confidence per observer and imaging technique. Each numbered line represents mean confidence score of single observer using each technique for cases with negative (A) and positive (B) findings for appendicitis. Optimal score would be 0 for cases with negative findings and 10 for cases with positive findings. FACT = focused appendiceal CT, A/P CT = abdominopelvic CT. "Enhanced" indicates use of colonic contrast material.

View larger version (18K): [in a new window]   Fig. 1B. —Graphs show diagnostic confidence per observer and imaging technique. Each numbered line represents mean confidence score of single observer using each technique for cases with negative (A) and positive (B) findings for appendicitis. Optimal score would be 0 for cases with negative findings and 10 for cases with positive findings. FACT = focused appendiceal CT, A/P CT = abdominopelvic CT. "Enhanced" indicates use of colonic contrast material.

View larger version (159K): [in a new window]   Fig. 2A. —Acute appendicitis readily diagnosed in 24-year-old man using all CT techniques but not identified on sonography. Minimal periappendiceal inflammatory stranding is present on all CT images. Unenhanced focused appendiceal CT scan shows appendicolith (black arrow) and slightly enlarged appendix (white arrow).

View larger version (151K): [in a new window]   Fig. 2B. —Acute appendicitis readily diagnosed in 24-year-old man using all CT techniques but not identified on sonography. Minimal periappendiceal inflammatory stranding is present on all CT images. Abdominopelvic CT scans show equivocal cecal apical thickening (arrowhead, B) and appendicolith (arrow, C) that is less conspicuous.

View larger version (150K): [in a new window]   Fig. 2C. —Acute appendicitis readily diagnosed in 24-year-old man using all CT techniques but not identified on sonography. Minimal periappendiceal inflammatory stranding is present on all CT images. Abdominopelvic CT scans show equivocal cecal apical thickening (arrowhead, B) and appendicolith (arrow, C) that is less conspicuous.

View larger version (170K): [in a new window]   Fig. 2D. —Acute appendicitis readily diagnosed in 24-year-old man using all CT techniques but not identified on sonography. Minimal periappendiceal inflammatory stranding is present on all CT images. Focused appendiceal CT scans with colonic contrast material show cecal apical thickening (arrowhead, D) and appendicoliths of intermediate conspicuity (arrow, E).

View larger version (171K): [in a new window]   Fig. 2E. —Acute appendicitis readily diagnosed in 24-year-old man using all CT techniques but not identified on sonography. Minimal periappendiceal inflammatory stranding is present on all CT images. Focused appendiceal CT scans with colonic contrast material show cecal apical thickening (arrowhead, D) and appendicoliths of intermediate conspicuity (arrow, E).

View larger version (161K): [in a new window]   Fig. 3A. —Sonography of 36-year-old woman shows that right lower abdominal quadrant anatomy is better seen without colonic contrast material. Sonogram obtained before administration of colonic contrast material depicts right lower abdominal quadrant anatomy with reasonably good quality. Note right iliac vessel adjacent to right iliopsoas muscle (arrow).

View larger version (157K): [in a new window]   Fig. 3B. —Sonography of 36-year-old woman shows that right lower abdominal quadrant anatomy is better seen without colonic contrast material. Sonogram after administration of colonic contrast material shows distended cecum (arrow) with floating specular reflectors but diminished anatomic visualization.

View larger version (140K): [in a new window]   Fig. 4A. —CT in 21-year-old man indicates suspicion of appendicitis but follow-up produces negative results. Unenhanced focused appendiceal CT scan shows 8-mm appendix (arrow) without definite inflammatory stranding.

View larger version (119K): [in a new window]   Fig. 4B. —CT in 21-year-old man indicates suspicion of appendicitis but follow-up produces negative results. Abdominopelvic CT scan shows appendix (arrow) that was seen on only one or two images.

View larger version (141K): [in a new window]   Fig. 4C. —CT in 21-year-old man indicates suspicion of appendicitis but follow-up produces negative results. Focused appendiceal CT scan with colonic contrast material shows 8-mm appendix (arrow) with hazy periappendiceal increase in attenuation, suggesting inflammation. Sonography failed to show appendix.

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