Skip to main content
×
Home
    • Aa
    • Aa

Diagnosis of appendicitis in adults by ultrasonography or computed tomography: A systematic review and meta-analysis

  • Adèle R. Weston (a1), Terri J. Jackson (a2) and Stephen Blamey (a3)
Abstract

Objectives: The use of ultrasonography and computed tomography (CT) in the diagnosis of appendicitis in adult patients was compared.

Methods: Systematic review and meta-analysis of current evidence in two clinical situations: unselected nonpregnant, adult patients with symptoms of appendicitis, and more selective use in only those patients who still have an equivocal diagnosis subsequent to routine clinical investigations.

Results: Meta-analysis of eligible studies shows CT to have better sensitivity and specificity than ultrasound in both clinical situations.

Conclusions: Application of these findings in clinical practice and/or policy would need to evaluate the better diagnostic performance of CT against its cost and availability. In addition, it is imperative that future studies be conducted in patient populations that are well-defined with respect to prior investigations. Sequelae of false-negative and false-positive diagnoses should also be evaluated.

Copyright
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

Abu-YousefMM, BleicherJJ, MaherJW, et al. 1987 High-resolution sonography of acute appendicitis. Am J Roentgenol. 149: 5358.

BalthazarEJ, BirnbaumBA, YeeJ, et al. 1994 Acute appendicitis: CT and US correlation in 100 patients. Radiology. 190: 3135.

BalthazarEJ, RofskyNM, ZuckerR. 1998 Appendicitis: The impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol. 93: 768771.

BerryJ Jr, MaltRA. 1984 Appendicitis near its centenary. Ann Surg. 200: 567575.

Breda VriesmanAC, KoleBJ, PuylaertJB. 2003 Effect of ultrasonography and optional computed tomography on the outcome of appendectomy. Eur Radiol. 13: 22782282.

CakirerS, BasakM, ColakogluB, et al. 2002 Diagnosis of acute appendicitis with unenhanced helical CT: A study of 130 patients. Emerg Radiol. 9: 155161.

ChenSC, ChenKM, WangSM, et al. 1998 Abdominal sonography screening of clinically diagnosed or suspected appendicitis before surgery. World J Surg. 22: 449452.

ChenSC, WangHP, HsuHY, et al. 2000 Accuracy of ED sonography in the diagnosis of acute appendicitis. Am J Emerg Med. 18: 449452.

ChesbroughRM, BurkhardTK, BalsaraZN, et al. 1993 Self-localization in US of appendicitis: An addition to graded compression. Radiology. 187: 349351.

ChoiYH, FischerE, HodaSA, et al. 1998 Appendiceal CT in 140 cases diagnostic criteria for acute and necrotizing appendicitis. Clin Imaging. 22: 252271.

DouglasCD, MacphersonNE, DavidsonPM, et al. 2000 Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. Br Med J. 321: 919922.

EgeG, AkmanH, SahinA, et al. 2002 Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis. Br J Radiol. 75: 721725.

FrankeC, BohnerH, YangQ, et al. 1999 Ultrasonography for diagnosis of acute appendicitis: Results of a prospective multicenter trial. World J Surg. 23: 141146.

FuchsJR, SchlambergJS, ShortsleeveMJ, et al. 2002 Impact of abdominal CT imaging on the management of appendicitis: An update. J Surg Res. 106: 131136.

FujiiY, HataJ, FutagamiK, et al. 2000 Ultrasonography improves diagnostic accuracy of acute appendicitis and provides cost savings to hospitals in Japan. J Ultrasound Med. 19: 409414.

FunakiB, GrosskreutzSR, FunakiCN. 1998 Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR Am J Roentgenol. 171: 9971001.

Garcia-AguayoFJ, GilP. 2000 Sonography in acute appendicitis: Diagnostic utility and influence upon management and outcome. Eur Radiol. 10: 18861893.

GimondoP, MirkP, LaBELLA A, et al. 1995 Acute appendicitis and diagnostic value of sonography: A prospective study of 77 surgically proven cases. Eur J Ultrasound. 2: 205209.

GumbsMA, SharmaK, GirishkumarHT, et al. 1993 Ultrasound as an aid in the diagnosis of acute appendicitis. Dig Surg. 10: 289291.

GwynnLK. 2001 The diagnosis of acute appendicitis: Clinical assessment versus computed tomography evaluation. J Emerg Med. 21: 119123.

IncesuL, CoskunA, SelcukMB, et al. 1997 Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol. 168: 669674.

JacobsJE, BirnbaumBA, MacariM, et al. 2001 Acute appendicitis: Comparison of helical CT diagnosis - focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material. Radiology. 220: 683690.

JohnH, NeffU, KelemenM. 1993 Appendicitis diagnosis today: Clinical and ultrasonic deductions. World J Surg. 17: 243249.

JuanCJ, HsuehCJ, HuangCW, et al. 2002 Age-specific and sex-specific differences in diagnostic accuracy of high-resolution ultrasonography for acute appendicitis. J Med Ultrasound. 10: 1019.

KamelIR, GoldbergSN, KeoganMT, et al. 2000 Right lower quadrant pain and suspected appendicitis: Nonfocused appendiceal CT—Review of 100 cases. Radiology. 217: 159163.

LaneMJ, LiuML, HuynhMD, et al. 1999 Suspected acute appendicitis: Nonenhanced helical CT in 300 consecutive patients. Radiology. 213: 341346.

LarsonJM, PeirceJC, EllingerDM, et al. 1989 The validity and utility of sonography in the diagnosis of appendicitis in the community setting. AJR Am J Roentgenol. 153: 687691.

LeeJH, JeongYK, HwangJC, et al. 2002 Graded compression sonography with adjuvant use of a posterior manual compression technique in the sonographic diagnosis of acute appendicitis. AJR Am J Roentgenol. 178: 863868.

LewisFR, HolcroftJW, BoeyJ, et al. 1975 Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg. 110: 677684.

MaloneAJ Jr, WolfCR, MalmedAS, et al. 1993 Diagnosis of acute appendicitis: Value of unenhanced CT. AJR Am J Roentgenol. 160: 763766.

MeiserG, MeissnerK. 1988 Contribution of sonography to the diagnosis of acute uncomplicated appendicitis. Dig Surg. 5: 7578.

NeutraRR. 1978 Appendicitis: Decreasing normal removals without increasing perforations. Med Care. 16: 956961.

O'MalleyME, WilsonSR. 2001 Ultrasonography and computed tomography of appendicitis and diverticulitis. Semin Roentgenol. 36: 138147.

OomsHWA, KoumansRKJ, HoKANG You Pj, et al. 1991 Ultrasonography in the diagnosis of acute appendicitis. Br J Surg. 78: 315318.

OrrRK, PorterD, HartmanD. 1995 Ultrasonography to evaluate adults for appendicitis: Decision making based on meta-analysis and probabilistic reasoning. Acad Emerg Med. 2: 644650.

PohlD, GolubR, SchwartzGE, et al. 1998 Appendiceal ultrasonography performed by nonradiologists: Does it help in the diagnostic process? J Ultrasound Med. 17: 217221.

PuylaertJB. 1988 The use of ultrasound in patients with clinical signs of appendicitis. Scand J Gastroenterol Suppl. 23: 5760.

PuylaertJB, RutgersPH, LalisangRI, et al. 1987 A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med. 317: 666669.

RamanSS, LuDSK, KadellBM, et al. 2002 Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: A 5-year review. AJR Am J Roentgenol. 178: 13191325.

RaoPM, BolandGW. 1998 Imaging of acute right lower abdominal quadrant pain. Clin Radiol. 53: 639649.

RaoPM, FeltmateCM, RheaJT, et al. 1999 Helical computed tomography in differentiating appendicitis and acute gynecologic conditions. Obstet Gynecol. 93: 417421.

RaoPM, RheaJT, NovellineRA, et al. 1997 Helical CT technique for the diagnosis of appendicitis: Prospective evaluation of a focused appendix CT examination. Radiology. 202: 139144.

RaoPM, RheaJT, NovellineRA, et al. 1997 Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. AJR Am J Roentgenol. 169: 12751280.

RettenbacherT, HollerwegerA, GritzmannN, et al. 2002 Appendicitis: Should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease? Gastroenterology. 123: 992998.

RiouxM. 1992 Sonographic detection of the normal and abnormal appendix. AJR Am J Roentgenol. 158: 773778.

SchwerkWB, WichtrupB, RuschoffJ, et al. 1990 Acute and perforated appendicitis: Current experience with ultrasound-aided diagnosis. World J Surg. 14: 271276.

SimonovskyV. 1999 Sonographic detection of normal and abnormal appendix. Clin Radiol. 54: 533539.

TerasawaT, BlackmoreCC, BentS, et al. 2004 Systematic review: Computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 141: 537546.

WadeDS, MorrowSE, BalsaraZN, et al. 1993 Accuracy of ultrasound in the diagnosis of acute appendicitis compared with the surgeon's clinical impression. Arch Surg. 128: 10391046.

WalkerS, HaunW, ClarkJ, et al. 2001 The value of limited computed tomography with rectal contrast in the diagnosis of acute appendicitis. Am J Surg. 180: 450455.

WeltmanDI, YuJ, KrumenackerJ, et al. 2000 Diagnosis of acute appendicitis: Comparison of 5- and 10-Mm CT sections in the same patient. Radiology. 216: 172177.

WijetungaR, TanBS, RouseJC, et al. 2001 Diagnostic accuracy of focused appendiceal CT in clinically equivocal cases of acute appendicitis. Radiology. 221: 747753.

WilcoxRT, TraversoLW. 1997 Have the evaluation and treatment of acute appendicitis changed with new technology? Surg Clin North Am. 77: 13551370.

WiseSW, LabuskiMR, KasalesCJ, et al. 2001 Comparative assessment of CT and sonographic techniques for appendiceal imaging. AJR Am J Roentgenol. 176: 933941.

WongSK, ChanLP, YeoA. 2002 Helical CT imaging and clinically suspected appendicitis: correlation of CT and histological findings. Clin Radiol. 57: 741745.

WorrellJA, DrolshagenLF, KellyTC, et al. 1990 Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria. J Ultrasound Med. 9: 145150.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Journal of Technology Assessment in Health Care
  • ISSN: 0266-4623
  • EISSN: 1471-6348
  • URL: /core/journals/international-journal-of-technology-assessment-in-health-care
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Full text views

Total number of HTML views: 4
Total number of PDF views: 12 *
Loading metrics...

Abstract views

Total abstract views: 81 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd May 2017. This data will be updated every 24 hours.