Imaging of appendicitis in adults

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 2mm, cross-sectional diameter greater than 6mm, 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 etal. Imaging of Appendicitis in Adults. Fortschr Röntgenstr 2014; 186: 551-558. © 2014 Georg Thieme Verlag KG Stuttgart New York.