Imaging of Appendicitis in Adults

 

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Abstract

Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2 mm, cross-sectional diameter greater than 6 mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance.

Key Points:

• US is the basic diagnostic method in case of suspected appendicitis.

• CT is necessary in patients with atypical presentation of appendicitis.

• MRI should be the first-line imaging test in pregnant women.

Citation Format:

• Karul M, Berliner C, Keller S et al. Imaging of Appendicitis in Adults. Fortschr Röntgenstr 2014; 186: 551 – 558

Zusammenfassung

Zur Akutdiagnostik der Appendizitis stehen drei radiologische Verfahren zur Verfügung: 1. Ultraschall (US); 2. Computertomografie (CT); 3. Magnetresonanztomografie (MRT). Während der transabdominelle Ultraschall zur Basisdiagnostik zählt, sollte die diagnostisch überlegene CT bei atypischen klinischen Appendizitiszeichen und Perforationsverdacht unverzüglich erfolgen. Besonders hervorzuheben ist die native Niedrigdosis-CT, die der Standarddosis-CT nach intravenöser Kontrastmittelapplikation in der Detektion von fünf Appendizitiszeichen (Wandverdickung größer 2 mm, vergrößerter Appendixdurchmesser mehr als 6 mm, Periappendizitis, Abszessformation und Appendicolith) ebenbürtig ist. Die MRT kommt bei Schwangeren und jungen Erwachsenen zum Einsatz. Diese Übersichtsarbeit stellt die Prinzipien der modernen Untersuchungstechniken sowie ihre klinischen Implikationen dar.

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• Supplementary Material