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Ultrasonography Should Be Used First to Diagnose Suspected Acute Appendicitis NEW YORK -- May 9, 2008 -- According to a study published in the May 2008 issue of the American Journal of Roentgenology, colour Doppler ultrasonography -- not computed tomography (CT) -- should be the first imaging examination for adult patients with suspected acute appendicitis. The study of 420 medical records found that ultrasonography correctly denied acute appendicitis in 303 of 312 adult patients, meaning that it had a 97% specificity rate, said Diana Gaitini, MD, Rambam Health Care Campus, Haifa, Israel. "When the patient does not have acute appendicitis, the negative result of the colour Doppler ultrasound examination is highly confident," she said. However, the sensitivity rate of ultrasonography was 74%, meaning the diagnosis was missed in 23 of 89 patients. Ultrasonography was found to be inconclusive in 17 patients. "We performed CT in 132 patients because the ultrasound examination was inconclusive or the patient was showing classical signs and symptoms of acute appendicitis, even though the ultrasound examination was negative," said Dr. Gaitini. The authors noted that CT correctly diagnosed acute appendicitis in 38 of 39 patients (99% sensitivity rate) and correctly denied acute appendicitis in all 92 patients (100% specificity rate). CT was inconclusive in 1 patient. "CT has a slightly higher specificity rate and a higher sensitivity rate than ultrasound, but ultrasound can help the radiologist make a definitive diagnosis in most patients," Dr. Gaitini said. "The higher diagnostic performances of CT need to be evaluated against its disadvantages. Lack of radiation exposure (which is especially important in a population of mostly young patients), higher availability, lower cost, and high specificity of colour Doppler ultrasound are the main reasons for trying ultrasound first," she said. SOURCE: American Roentgen Ray Society E-mail this page to a friend or colleague! To print, use this version