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A new technique for the diagnosis of acute appendicitis: abdominal CT with compression to the right lower quadrant

  • Emergency Radiology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To determine the diagnostic accuracy of abdominal CT with compression to the right lower quadrant (RLQ) in adults with acute appendicitis.

Methods

168 patients (age range, 18–78 years) were included who underwent contrast-enhanced CT for suspected appendicitis performed either using compression to the RLQ (n = 71) or a standard protocol (n = 97). Outer diameter of the appendix, appendiceal wall thickening, luminal content and associated findings were evaluated in each patient. Kruskal-Wallis, Fisher’s and Pearson's chi-squared tests were used for statistical analysis.

Results

There was no significant difference in the mean outer diameter (MOD) between compression CT scans (10.6 ± 1.9 mm) and standard protocol (11.2 ± 2.3 mm) in patients with acute appendicitis (P = 1). MOD was significantly lower in the compression group (5.2 ± 0.8 mm) compared to the standard protocol (6.5 ± 1.1 mm) (P < 0.01) in patients without appendicitis. A cut-off value of 6.75 mm for the outer diameter of the appendix was found to be 100% sensitive in the diagnosis of acute appendicitis for both groups. The specificity was higher for compression CT technique (67.7 vs. 94.9%).

Conclusion

Normal appendix diameter was significantly smaller in the compression-CT group compared to standard-CT group, increasing diagnostic accuracy of abdominal compression CT.

Key points

• Normal appendix diameter is significantly smaller in compression CT.

• Compression could force contrast material to flow through the appendiceal lumen.

• Compression CT may be a CT counterpart of graded compression US.

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Abbreviations

AA:

Acute appendicitis

AUC:

Area under the curve

CT:

Computed tomography

EC:

External compression

eGFR:

Estimated glomerular filtration rate

RLQ:

Right lower quadrant

ROC:

Receiver operating characteristics

SB:

Saline bag

SD:

Standard deviation

US:

Ultrasonography

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Acknowledgements

The authors thank Assos. Prof. Erdem Karabulut, Phd (Department of Biostatistics, Hacettepe University, School of Medicine) for his help with the statistical analysis.

Author information

Authors and Affiliations

  1. Department of Radiology, Hacettepe University Faculty of Medicine, Sıhhiye, Ankara, 06100, Turkey

    Abidin Kılınçer, Erhan Akpınar, Emre Ünal, Ali Devrim Karaosmanoğlu, Deniz Akata & Mustafa Özmen

  2. Department of Emergency Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Bülent Erbil

  3. Department of General Surgery, Hacettepe University Faculty of Medicine, Ankara, Turkey

    Volkan Kaynaroğlu

Authors
  1. Abidin Kılınçer
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  2. Erhan Akpınar
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  3. Bülent Erbil
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  4. Emre Ünal
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  5. Ali Devrim Karaosmanoğlu
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  6. Volkan Kaynaroğlu
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  7. Deniz Akata
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  8. Mustafa Özmen
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Corresponding author

Correspondence to Erhan Akpınar.

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Guarantor

The scientific guarantor of this publication is Prof. Erhan Akpınar, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Assos. Prof. Erdem Karabulut, Phd (Department of Biostatistics, Hacettepe University, School of Medicine) kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all patients in this study.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in the annual meeting of RSNA in 2014.

Methodology

• prospective

• diagnostic study

• performed at one institution

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Kılınçer, A., Akpınar, E., Erbil, B. et al. A new technique for the diagnosis of acute appendicitis: abdominal CT with compression to the right lower quadrant. Eur Radiol 27, 3317–3325 (2017). https://doi.org/10.1007/s00330-016-4728-1

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  • DOI: https://doi.org/10.1007/s00330-016-4728-1

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