Low vs. standard dose computed tomography in suspected acute appendicitis: Is it time for a change?
BACKGROUND
Clinical diagnosis is accurate in only 80% of patients with suspected appendicitis with negative appendectomy rates of up to 21%. In the UK the use of standard-dose CT (SDCT) is conservative due to concerns over radiation exposure and resource implications. The use of low dose computer tomography (LDCT) instead of standard dose computer tomography (SDCT) may partially address these concerns.


OBJECTIVE
To compare LDCT and SDCT in the diagnosis of appendicitis.


METHODS
A literature search of the EMBASE and MEDLINE databases in July 2015 was conducted using the keywords 'low dose CT' and 'appendicitis'. Data were analysed and p values calculated using the Chi-square test. P values less than 0.05 were considered to be significant.


RESULTS
LDCT (1.2-5.3 mSv) was not inferior to SDCT (5.2-10.2 mSv) in the diagnosis of acute appendicitis and proposing alternative diagnoses. SDCT was superior to LDCT in the negative predictive value of diagnosis of appendiceal perforation. There was no significant difference between LDCT and SDCT in negative appendectomy rate, appendiceal perforation rate and the need for additional imaging.


CONCLUSIONS
LDCT is not inferior to SDCT in the diagnosis of acute appendicitis and proposing alternative diagnoses. Further studies are recommended to further assess the potential role of LDCT & its cost effectiveness. Its use may improve the current management of patients with suspected acute appendicitis.
School of Medicine, University of Aberdeen, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom.
Noha E
NE
Aly
Department of Diagnostic Imaging, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom.
Dympna
D
McAteer
Laparoscopic Colorectal Surgery & Training Unit, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom. Electronic address: emad.aly@nhs.net.
Emad H
EH
Aly
D000208:Acute Disease; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
Acute appendicitis; CT; Low dose; Standard dose