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

Published online by Cambridge University Press:  04 August 2005

Adèle R. Weston ,
Terri J. Jackson  and
Stephen Blamey
Adèle R. Weston
Affiliation:
Health Technology Analysts Pty Ltd.
Terri J. Jackson
Affiliation:
LaTrobe University
Stephen Blamey
Affiliation:
Monash Medical Centre
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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.

Keywords

AppendicitisDiagnosisSpiral computed tomographyUltrasonographyAcademic review
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 3 , July 2005 , pp. 368 - 379
Copyright
© 2005 Cambridge University Press

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References

Abu-Yousef MM, Bleicher JJ, Maher JW, et al. 1987 High-resolution sonography of acute appendicitis. Am J Roentgenol. 149: 53– 58.Google Scholar
Balthazar EJ, Birnbaum BA, Yee J, et al. 1994 Acute appendicitis: CT and US correlation in 100 patients. Radiology. 190: 31– 35.Google Scholar
Balthazar EJ, Rofsky NM, Zucker R. 1998 Appendicitis: The impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol. 93: 768– 771.Google Scholar
Barraclough BH, Liddell SJ. 1983 Appendicectomy: A private hospital audit. Aust Clin Rev. 10: 10– 16.Google Scholar
Berry J Jr, Malt RA. 1984 Appendicitis near its centenary. Ann Surg. 200: 567– 575.Google Scholar
Breda Vriesman AC, Kole BJ, Puylaert JB. 2003 Effect of ultrasonography and optional computed tomography on the outcome of appendectomy. Eur Radiol. 13: 2278– 2282.Google Scholar
Cakirer S, Basak M, Colakoglu B, et al. 2002 Diagnosis of acute appendicitis with unenhanced helical CT: A study of 130 patients. Emerg Radiol. 9: 155– 161.Google Scholar
Chen SC, Chen KM, Wang SM, et al. 1998 Abdominal sonography screening of clinically diagnosed or suspected appendicitis before surgery. World J Surg. 22: 449– 452.Google Scholar
Chen SC, Wang HP, Hsu HY, et al. 2000 Accuracy of ED sonography in the diagnosis of acute appendicitis. Am J Emerg Med. 18: 449– 452.Google Scholar
Chesbrough RM, Burkhard TK, Balsara ZN, et al. 1993 Self-localization in US of appendicitis: An addition to graded compression. Radiology. 187: 349– 351.Google Scholar
Choi YH, Fischer E, Hoda SA, et al. 1998 Appendiceal CT in 140 cases diagnostic criteria for acute and necrotizing appendicitis. Clin Imaging. 22: 252– 271.Google Scholar
Douglas CD, Macpherson NE, Davidson PM, et al. 2000 Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. Br Med J. 321: 919– 922.Google Scholar
Drinkovic I, Brkljacic B, Odak D, et al. 1995 Value of ultrasound in the diagnosis of acute appendicitis. Radiol Oncol. 29: 190– 193.Google Scholar
Ege G, Akman H, Sahin A, et al. 2002 Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis. Br J Radiol. 75: 721– 725.Google Scholar
Fa EM, Cronan JJ. 1989 Compression ultrasonography as an aid in the differential diagnosis of appendicitis. Surg Gynecol Obstet. 169: 290– 298.Google Scholar
Ford RD, Passinault WJ, Morse ME. 1994 Diagnostic ultrasound for suspected appendicitis: Does the added cost produce a better outcome? Am Surg. 60: 895– 898.Google Scholar
Franke C, Bohner H, Yang Q, et al. 1999 Ultrasonography for diagnosis of acute appendicitis: Results of a prospective multicenter trial. World J Surg. 23: 141– 146.Google Scholar
Fuchs JR, Schlamberg JS, Shortsleeve MJ, et al. 2002 Impact of abdominal CT imaging on the management of appendicitis: An update. J Surg Res. 106: 131– 136.Google Scholar
Fujii Y, Hata J, Futagami K, et al. 2000 Ultrasonography improves diagnostic accuracy of acute appendicitis and provides cost savings to hospitals in Japan. J Ultrasound Med. 19: 409– 414.Google Scholar
Funaki B, Grosskreutz SR, Funaki CN. 1998 Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital. AJR Am J Roentgenol. 171: 997– 1001.Google Scholar
Garcia-Aguayo FJ, Gil P. 2000 Sonography in acute appendicitis: Diagnostic utility and influence upon management and outcome. Eur Radiol. 10: 1886– 1893.Google Scholar
Gimondo P, Mirk P, La BELLA A, et al. 1995 Acute appendicitis and diagnostic value of sonography: A prospective study of 77 surgically proven cases. Eur J Ultrasound. 2: 205– 209.Google Scholar
Gumbs MA, Sharma K, Girishkumar HT, et al. 1993 Ultrasound as an aid in the diagnosis of acute appendicitis. Dig Surg. 10: 289– 291.Google Scholar
Gutierrez CJ, Mariano MC, Faddis DM, et al. 1999 Doppler ultrasound accurately screens patients with appendicitis. Am Surg. 65: 1015– 1017.Google Scholar
Gwynn LK. 2001 The diagnosis of acute appendicitis: Clinical assessment versus computed tomography evaluation. J Emerg Med. 21: 119– 123.Google Scholar
Incesu L, Coskun A, Selcuk MB, et al. 1997 Acute appendicitis: MR imaging and sonographic correlation. AJR Am J Roentgenol. 168: 669– 674.Google Scholar
Jacobs JE, Birnbaum BA, Macari M, 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: 683– 690.Google Scholar
Jahn H, Mathiesen FK, Neckelmann K, et al. 1997 Comparison of clinical judgment and diagnostic ultrasonography in the diagnosis of acute appendicitis: Experience with a score-aided diagnosis. Eur J Surg. 163: 433– 443.Google Scholar
John H, Neff U, Kelemen M. 1993 Appendicitis diagnosis today: Clinical and ultrasonic deductions. World J Surg. 17: 243– 249.Google Scholar
Juan CJ, Hsueh CJ, Huang CW, et al. 2002 Age-specific and sex-specific differences in diagnostic accuracy of high-resolution ultrasonography for acute appendicitis. J Med Ultrasound. 10: 10– 19.Google Scholar
Kamel IR, Goldberg SN, Keogan MT, et al. 2000 Right lower quadrant pain and suspected appendicitis: Nonfocused appendiceal CT—Review of 100 cases. Radiology. 217: 159– 163.Google Scholar
Kang WM, Lee CH, Chou YH, et al. 1989 A clinical evaluation of ultrasonography in the diagnosis of acute appendicitis. Surgery. 105: 154– 159.Google Scholar
Lane MJ, Liu ML, Huynh MD, et al. 1999 Suspected acute appendicitis: Nonenhanced helical CT in 300 consecutive patients. Radiology. 213: 341– 346.Google Scholar
Larson JM, Peirce JC, Ellinger DM, et al. 1989 The validity and utility of sonography in the diagnosis of appendicitis in the community setting. AJR Am J Roentgenol. 153: 687– 691.Google Scholar
Lee JH, Jeong YK, Hwang JC, 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: 863– 868.Google Scholar
Lewis FR, Holcroft JW, Boey J, et al. 1975 Appendicitis. A critical review of diagnosis and treatment in 1,000 cases. Arch Surg. 110: 677– 684.Google Scholar
Malone AJ Jr, Wolf CR, Malmed AS, et al. 1993 Diagnosis of acute appendicitis: Value of unenhanced CT. AJR Am J Roentgenol. 160: 763– 766.Google Scholar
Meiser G, Meissner K. 1988 Contribution of sonography to the diagnosis of acute uncomplicated appendicitis. Dig Surg. 5: 75– 78.Google Scholar
Neutra RR. 1978 Appendicitis: Decreasing normal removals without increasing perforations. Med Care. 16: 956– 961.Google Scholar
O'Malley ME, Wilson SR. 2001 Ultrasonography and computed tomography of appendicitis and diverticulitis. Semin Roentgenol. 36: 138– 147.Google Scholar
Old JL, Dusing RW, Yap W, et al. 2005 Imaging for suspected appendicitis. Am Fam Physician. 71: 71– 78.Google Scholar
Ooms HWA, Koumans RKJ, Ho KANG You Pj, et al. 1991 Ultrasonography in the diagnosis of acute appendicitis. Br J Surg. 78: 315– 318.Google Scholar
Orr RK, Porter D, Hartman D. 1995 Ultrasonography to evaluate adults for appendicitis: Decision making based on meta-analysis and probabilistic reasoning. Acad Emerg Med. 2: 644– 650.Google Scholar
Pickuth D, Spielmann RP. 2001 Unenhanced spiral CT for evaluating acute appendicitis in daily routine. A prospective study. Hepatogastroenterology. 48: 140– 142.Google Scholar
Pohl D, Golub R, Schwartz GE, et al. 1998 Appendiceal ultrasonography performed by nonradiologists: Does it help in the diagnostic process? J Ultrasound Med. 17: 217– 221.Google Scholar
Puylaert JB. 1988 The use of ultrasound in patients with clinical signs of appendicitis. Scand J Gastroenterol Suppl. 23: 57– 60.Google Scholar
Puylaert JB, Rutgers PH, Lalisang RI, et al. 1987 A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med. 317: 666– 669.Google Scholar
Raman SS, Lu DSK, Kadell BM, et al. 2002 Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: A 5-year review. AJR Am J Roentgenol. 178: 1319– 1325.Google Scholar
Rao PM, Boland GW. 1998 Imaging of acute right lower abdominal quadrant pain. Clin Radiol. 53: 639– 649.Google Scholar
Rao PM, Feltmate CM, Rhea JT, et al. 1999 Helical computed tomography in differentiating appendicitis and acute gynecologic conditions. Obstet Gynecol. 93: 417– 421.Google Scholar
Rao PM, Rhea JT, Novelline RA, et al. 1997 Helical CT technique for the diagnosis of appendicitis: Prospective evaluation of a focused appendix CT examination. Radiology. 202: 139– 144.Google Scholar
Rao PM, Rhea JT, Novelline RA, et al. 1997 Helical CT combined with contrast material administered only through the colon for imaging of suspected appendicitis. AJR Am J Roentgenol. 169: 1275– 1280.Google Scholar
Rettenbacher T, Hollerweger A, Gritzmann N, et al. 2002 Appendicitis: Should diagnostic imaging be performed if the clinical presentation is highly suggestive of the disease? Gastroenterology. 123: 992– 998.Google Scholar
Rioux M. 1992 Sonographic detection of the normal and abnormal appendix. AJR Am J Roentgenol. 158: 773– 778.Google Scholar
Schwerk WB, Wichtrup B, Ruschoff J, et al. 1990 Acute and perforated appendicitis: Current experience with ultrasound-aided diagnosis. World J Surg. 14: 271– 276.Google Scholar
Sim KT, Picone S, Crade M, et al. 1989 Ultrasound with graded compression in the evaluation of acute appendicitis. J Natl Med Assoc. 81: 954– 957.Google Scholar
Simonovsky V. 1999 Sonographic detection of normal and abnormal appendix. Clin Radiol. 54: 533– 539.Google Scholar
Skaane P, Schistad O, Amland PF, et al. 1997 Routine ultrasonography in the diagnosis of acute appendicitis: A valuable tool in daily practice? Am Surg. 63: 937– 942.Google Scholar
Terasawa T, Blackmore CC, Bent S, et al. 2004 Systematic review: Computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med. 141: 537– 546.Google Scholar
Velanovich V, Satava R. 1992 Balancing the normal appendectomy rate with the perforated appendicitis rate: Implications for quality assurance. Am Surg. 58: 264– 269.Google Scholar
Verroken R, Penninckx F, Van HOE L, et al. 1996 Diagnostic accuracy of ultrasonography and surgical decision-making in patients referred for suspicion of appendicitis. Acta Chir Belg. 96: 158– 160.Google Scholar
Wade DS, Morrow SE, Balsara ZN, et al. 1993 Accuracy of ultrasound in the diagnosis of acute appendicitis compared with the surgeon's clinical impression. Arch Surg. 128: 1039– 1046.Google Scholar
Walker S, Haun W, Clark J, et al. 2001 The value of limited computed tomography with rectal contrast in the diagnosis of acute appendicitis. Am J Surg. 180: 450– 455.Google Scholar
Weltman DI, Yu J, Krumenacker J, et al. 2000 Diagnosis of acute appendicitis: Comparison of 5- and 10-Mm CT sections in the same patient. Radiology. 216: 172– 177.Google Scholar
Wen SW, Naylor CD. 1995 Diagnostic accuracy and short-term surgical outcomes in cases of suspected acute appendicitis. CMAJ. 152: 1617– 1626.Google Scholar
Wijetunga R, Tan BS, Rouse JC, et al. 2001 Diagnostic accuracy of focused appendiceal CT in clinically equivocal cases of acute appendicitis. Radiology. 221: 747– 753.Google Scholar
Wilcox RT, Traverso LW. 1997 Have the evaluation and treatment of acute appendicitis changed with new technology? Surg Clin North Am. 77: 1355– 1370.Google Scholar
Wise SW, Labuski MR, Kasales CJ, et al. 2001 Comparative assessment of CT and sonographic techniques for appendiceal imaging. AJR Am J Roentgenol. 176: 933– 941.Google Scholar
Wong SK, Chan LP, Yeo A. 2002 Helical CT imaging and clinically suspected appendicitis: correlation of CT and histological findings. Clin Radiol. 57: 741– 745.Google Scholar
Worrell JA, Drolshagen LF, Kelly TC, et al. 1990 Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria. J Ultrasound Med. 9: 145– 150.Google Scholar
Zeidan BS, Wasser T, Nicholas GG. 1997 Ultrasonography in the diagnosis of acute appendicitis. J R Coll Surg Edinb. 42: 24– 26.Google Scholar