OAK BROOK, Ill. (Ivanhoe Newswire) -- Preoperative computed tomography
(CT) may help reduce unnecessary surgeries in women of reproductive age with
suspected acute appendicitis.
"We found that rising utilization of preoperative CT over the past decade, along
with advances in CT technology, coincided with a significant decrease in
negative appendectomies among women 45 years and younger," co-author Courtney A.
Coursey, M.D., a radiologist at Emory University in Atlanta, Ga., was quoted as
saying.
Acute appendicitis is inflammation of the appendix, a fingerlike organ attached
to the large intestine in the lower right area of the abdomen. An inflamed
appendix can perforate, resulting in a life-threatening infection.
While surgical removal of the appendix is the common treatment for acute
appendicitis, diagnosis is not always clear clinically. Prior to the advent of
CT, in inconclusive cases, physicians would often remove the appendix as a
precaution. Historically, this resulted in a high rate of unnecessary
appendectomies, with rates as high as 40 percent in women.
Negative appendectomy rates are generally higher in women due to gynecologic
pathology that can confound appendicitis diagnosis. For instance, symptomatic
ovarian cysts can cause lower abdominal pain similar to that of appendicitis.
CT
now has the potential to reduce the negative appendectomy rate. An acutely
inflamed appendix appears thick-walled on CT, and adjacent inflammatory changes
are often visible. If the appendix is perforated, fluid next to the appendix can
be visible on CT.
To determine the impact of CT on negative appendectomy rates, Dr. Coursey and
colleagues reviewed a surgical database of 925 patients who underwent urgent
appendectomy at Duke University Medical Center between January 1998 and
September 2007. Over the 10-year period, the percentage of patients who had
preoperative CT increased from 18.5 percent in 1998 to 93.2 percent in 2007.
The increased use of CT corresponded with a lower negative appendectomy rate for
women age 45 years or younger. The negative appendectomy rate among those women
dropped from 42.9 percent in 1998 to 7.1 percent in 2007. The shift from
single-detector CT to multi-detector CT and other advances in CT technology also
correlated with a reduction in false-positive diagnoses.
"CT is a very helpful test for women 45 years and younger based on the overall
trends we observed during the 10-year period," Dr. Coursey said.
Increased use of preoperative CT at Duke did not coincide with a lower negative
appendectomy rate in men, regardless of age, or in women older than 45 years.
Dr. Coursey suggested that the lack of a decline might be attributable to a very
low negative appendectomy rate in those groups in the first place.
"Although it's a terrific test, CT and our interpretation of CT images are not
100 percent perfect," said Dr. Coursey. "Therefore, it may be difficult to
improve significantly upon diagnosis in groups with an already low negative
appendectomy rate."
SOURCE: Radiology, February, 2010
