title: A novel reporting system to improve accuracy in appendicitis imaging.
abstract: OBJECTIVE
  The purpose of this study was to ascertain if standardized radiologic reporting for appendicitis imaging increases diagnostic accuracy.
  
  
  METHODS
  We developed a standardized appendicitis reporting system that includes objective imaging findings common in appendicitis and a certainty score ranging from 1 (definitely not appendicitis) through 5 (definitely appendicitis). Four radiologists retrospectively reviewed the preoperative CT scans of 96 appendectomy patients using our reporting system. The presence of appendicitis-specific imaging findings and certainty scores were compared with final pathology. These comparisons were summarized using odds ratios (ORs) and the AUC.
  
  
  RESULTS
  The appendix was visualized on CT in 89 patients, of whom 71 (80%) had pathologically proven appendicitis. Imaging findings associated with appendicitis included appendiceal diameter (odds ratio [OR] = 14 [> 10 vs < 6 mm]; p = 0.002), periappendiceal fat stranding (OR = 8.9; p < 0.001), and appendiceal mucosal hyperenhancement (OR = 8.7; p < 0.001). Of 35 patients whose initial clinical findings were reported as indeterminate, 28 (80%) had appendicitis. In this initially indeterminate group, using the standardized reporting system, radiologists assigned higher certainty scores (4 or 5) in 21 of the 28 patients with appendicitis (75%) and lower scores (1 or 2) in five of the seven patients without appendicitis (71%) (AUC = 0.90; p = 0.001).
  
  
  CONCLUSIONS
  Standardized reporting and grading of objective imaging findings correlated well with postoperative pathology and may decrease the number of CT findings reported as indeterminate for appendicitis. Prospective evaluation of this reporting system on a cohort of patients with clinically suspected appendicitis is currently under way.
authors.affiliation: 1 Department of Radiology, University of Washington, 1959 NE Pacific St, UW Mailbox 357115, Seattle, WA 98195.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Godwin
authors.forename: Frederick T
authors.initials: FT
authors.lastname: Drake
authors.forename: Vlad V
authors.initials: VV
authors.lastname: Simianu
authors.forename: Jabi E
authors.initials: JE
authors.lastname: Shriki
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Hippe
authors.forename: Manjiri
authors.initials: M
authors.lastname: Dighe
authors.forename: Sarah
authors.initials: S
authors.lastname: Bastawrous
authors.forename: Carlos
authors.initials: C
authors.lastname: Cuevas
authors.forename: David
authors.initials: D
authors.lastname: Flum
authors.forename: Puneet
authors.initials: P
authors.lastname: Bhargava
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000000981:diagnostic imaging*; D004282:Documentation / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011856:Radiographic Image Enhancement / Q000379:methods / Q000592:standards*; D011873:Radiology Information Systems / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards*; D014481:United States; D055815:Young Adult
keywords: CT; appendectomy; appendicitis; standardized reporting