Preoperative Multidetector Computed Tomography (MDCT) Using Contrast Media for Suspected Acute Appendicitis in Adults: Value and Accuracy

Abstract
Background: Acute Appendicitis (AA) is considered the commonest cause of acute abdomen in adults. Its clinical presentation is not always clear and only 70% of patients have the classic signs and symptoms. Quick and safe diagnosis can be acquired in classic cases clinically assisted by laboratory results. Atypical presentation can be up to one third of patients with AA. Other abdominal conditions may also represent as AA especially in women. Also, the diagnostic value of labo-ratory markers (CRP and WCC) remains a controversial. Missing diagnosis of AA leads to severe complications. Ultrasound (US) examination has many limitations in diagnosis of AA. Multi-Detector Computed Tomography (MDCT) is well established for diagnosis of AA with high sensitivity. So, the radiologist can confidently diagnose or exclude AA, its severity and complications to guide appropriate manage-ment.
Aim of Study: The aim of this study is to assess the diagnostic value and accuracy of pre-operative MDCT in suspected AA in adults.
Patients and Methods: This prospective study included 200 adult patients presented with clinical picture of AA, either typical or atypical. Post intravenous contrast MDCT was performed for all patients. Axial images were reconstructed with coronal and sagittal reformatted images. Then images were evaluated for the presence or absence of AA, associated complications or other pelviabdominal abnormalities.
Results: Two hundred patients (120 females and 80 males with age range between 21-65 years and mean age 35) were having clinical presentation of acute right iliac fossa pain. According to the CT findings 140 patients (70%) diagnosed as AA and 60 patients (30%) were negative for appendicitis. The CT findings were limited to the appendix only in 75 patients (37.5%) and were coping with simple acute appendi-citis. A group of 39 patients (19.5%) diagnosed as AA with peri-appendicular inflammatory changes. CT findings in a small group of patients (12 patients 6%) showed mixed inflammatory reaction with regional lymphadenopathy and minimal free fluid they were diagnosed as AA with phlegmon. CT signs of perforated appendix detected in 10 patients (5%). Only 4 patients (2%) diagnosed as appendicular mucocele. The other 60 patients (30%) were negative for appendicitis. 20 patients (10%) showed right ovarian cysts, 10 patients (5%) had right ureteric stones, 5 patients (2.5%) had epiploic appendagitis and 25 patients (12.5%) negative for any pathol-ogy. All cases with positive CT findings subjected to surgery and the operative findings were matching with the CT findings.
Conclusion: MDCT is an accurate, effective technique for diagnosing acute appendicitis. It also affects surgical management plan. In addition, it avoids unnecessary operation.