title: Stratified computed tomography findings improve diagnostic accuracy for appendicitis.
abstract: OBJECTIVE
  To improve the diagnostic accuracy in patients with symptoms and signs of appendicitis, but without confirmative computed tomography (CT) findings.
  
  
  METHODS
  We retrospectively reviewed the database of 224 patients who had been operated on for the suspicion of appendicitis, but whose CT findings were negative or equivocal for appendicitis. The patient population was divided into two groups: a pathologically proven appendicitis group (n = 177) and a non-appendicitis group (n = 47). The CT images of these patients were re-evaluated according to the characteristic CT features as described in the literature. The re-evaluations and baseline characteristics of the two groups were compared.
  
  
  RESULTS
  The two groups showed significant differences with respect to appendiceal diameter, and the presence of periappendiceal fat stranding and intraluminal air in the appendix. A larger proportion of patients in the appendicitis group showed distended appendices larger than 6.0 mm (66.3% vs 37.0%; P < 0.001), periappendiceal fat stranding (34.1% vs 8.9%; P = 0.001), and the absence of intraluminal air (67.6% vs 48.9%; P = 0.024) compared to the non-appendicitis group. Furthermore, the presence of two or more of these factors increased the odds ratio to 6.8 times higher than baseline (95%CI: 3.013-15.454; P < 0.001).
  
  
  CONCLUSIONS
  Appendiceal diameter and wall thickening, fat stranding, and absence of intraluminal air can be used to increased diagnostic accuracy for appendicitis with equivocal CT findings.
authors.affiliation: Geon Park, Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon 301-723, South Korea.
authors.forename: Geon
authors.initials: G
authors.lastname: Park
authors.affiliation: Geon Park, Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon 301-723, South Korea.
authors.forename: Sang Chul
authors.initials: SC
authors.lastname: Lee
authors.affiliation: Geon Park, Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon 301-723, South Korea.
authors.forename: Byung-Jo
authors.initials: BJ
authors.lastname: Choi
authors.affiliation: Geon Park, Department of Radiology, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon 301-723, South Korea.
authors.forename: Say-June
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D001065:Appendix / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D003287:Contrast Media; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: Appendectomy; Appendicitis; Computed tomography; Diagnostic accuracy; Re-evaluation