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CT following US for possible appendicitis: anatomic coverage

  • Computed Tomography
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Abstract

Objective

To determine superior-inferior anatomic borders for CT following inconclusive/nondiagnostic US for possible appendicitis.

Methods

Ninety-nine patients with possible appendicitis and inconclusive/nondiagnostic US followed by CT were included in this retrospective study. Two radiologists reviewed CT images and determined superior-inferior anatomic borders required to diagnose or exclude appendicitis and diagnose alternative causes. This “targeted” coverage was used to estimate potential reduction in anatomic coverage compared to standard abdominal/pelvic CT.

Results

The study group included 83 women and 16 men; mean age 32 (median, 29; range 18-73) years. Final diagnoses were: nonspecific abdominal pain 50/99 (51 %), appendicitis 26/99 (26 %), gynaecological 12/99 (12 %), gastrointestinal 9/99 (10 %), and musculoskeletal 2/99 (2 %). Median dose-length product for standard CT was 890.0 (range, 306.3 – 2493.9) mGy.cm. To confidently diagnose/exclude appendicitis or identify alternative diagnoses, maximum superior-inferior anatomic CT coverage was the superior border of L2-superior border of pubic symphysis, for both reviewers. Targeted CT would reduce anatomic coverage by 30-55 % (mean 39 %, median 40 %) compared to standard CT.

Conclusions

When CT is performed for appendicitis following inconclusive/nondiagnostic US, targeted CT from the superior border of L2-superior border of pubic symphysis can be used resulting in significant reduction in exposure to ionizing radiation compared to standard CT.

Key Points

• When CT is used following inconclusive/ nondiagnostic ultrasound, anatomic coverage can be reduced.

• CT from L2 to pubic symphysis can be used to diagnose/exclude appendicitis.

• Reduced anatomic coverage for CT results in reduced exposure to ionizing radiation.

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Acknowledgments

The scientific guarantor of this publication is Dr Martin E. O’Malley. 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. The authors state that this work has not received any funding. One of the authors has significant statistical expertise: Hadas Moshonov, PhD. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, observational, performed at one institution.

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Author notes

  1. Fawaz Alharbi

    Present address: Department of Medical Imaging, Qassim University, Buraydah, Qassim, Saudi Arabia

Authors and Affiliations

  1. Joint Department of Medical Imaging, University of Toronto, Princess Margaret Hospital, 3-920, 610 University Avenue, Toronto, Ontario, M5G 2 M9, Canada

    Martin E. O’Malley

  2. Joint Department of Medical Imaging, University of Toronto, Toronto General Hospital, NCSB 1C572, 585 University Avenue, Toronto, Ontario, M5G 2 N2, Canada

    Fawaz Alharbi

  3. Joint Department of Medical Imaging, University of Toronto, Mount Sinai Hospital, Room 567, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada

    Tanya P. Chawla

  4. Joint Department of Medical Imaging, University of Toronto, OPG Building, 2nd Floor, North Side, 700 University Avenue, Toronto, Ontario, M5G 1X6, Canada

    Hadas Moshonov

Authors
  1. Martin E. O’Malley
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  2. Fawaz Alharbi
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  3. Tanya P. Chawla
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  4. Hadas Moshonov
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Corresponding author

Correspondence to Martin E. O’Malley.

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O’Malley, M.E., Alharbi, F., Chawla, T.P. et al. CT following US for possible appendicitis: anatomic coverage. Eur Radiol 26, 532–538 (2016). https://doi.org/10.1007/s00330-015-3778-0

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  • DOI: https://doi.org/10.1007/s00330-015-3778-0

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