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Preoperative CT Useful for Younger Women With Suspected Appendicitis OAK BROOK, Ill -- January 26, 2010 -- Preoperative computed tomography (CT) may help reduce unnecessary surgeries in women of reproductive age with suspected acute appendicitis, according to a study appearing in the February issue of the journal Radiology. “We found that rising utilisation of preoperative CT over the past decade, along with advances in CT technology, coincided with a significant decrease in negative appendectomies among women 45 years and younger,” said Courtney A. Coursey, MD, Emory University, Atlanta, Georgia, who co-authored this study while at Duke University Medical Center, Durham, North Carolina. While surgical removal of the appendix is the common treatment for acute appendicitis, diagnosis is not always clear clinically. Negative appendectomy rates are generally higher in women due to gynaecologic pathology that can confound appendicitis diagnosis. For instance, symptomatic ovarian cysts can cause lower abdominal pain similar to that from appendicitis. CT is now often used in the evaluation of suspected appendicitis and has the potential to reduce the negative appendectomy rate. An acutely inflamed appendix appears thick-walled on CT, and adjacent inflammatory changes are often visible. If the appendix is perforated, fluid next to the appendix may be visible on CT. There have been contradictory reports in the medical literature regarding whether or not the increased use of CT has resulted in a lower negative appendectomy rate. To determine the impact of CT on negative appendectomy rates, Dr. Coursey and colleagues reviewed a surgical database of 925 patients who underwent urgent appendectomy at Duke University between January 1998 and September 2007. The percentage of patients who had preoperative CT increased significantly over the 10-year period, from 18.5% in 1998 to 93.2% in 2007. The increased use of CT corresponded with a lower negative appendectomy rate for women aged 45 years or younger. The negative appendectomy rate among those women dropped from 42.9% in 1998 to 7.1% in 2007. The shift from single-detector CT to multi-detector CT and other advances in CT technology also correlated with a reduction in false-positive diagnoses. “CT is a very helpful test for women 45 years and younger based on the overall trends we observed during the 10-year period,” said Dr. Coursey. Increased use of preoperative CT at Duke University Medical Center did not coincide with a lower negative appendectomy rate in men, regardless of age, or in women aged older than 45 years. Dr. Coursey suggested that the lack of a decline might be attributable to a very low negative appendectomy rate in those groups at the beginning of the study period. “Although it’s a terrific test, CT and our interpretation of CT images are not 100% perfect,” she said. “Therefore, it may be difficult to improve significantly upon diagnosis in groups with an already low negative appendectomy rate.” SOURCE: Radiological Society of North America E-mail this page to a friend or colleague! To print, use this version