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 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.

Key words

abdomen - CT - MR imaging - ultrasound - appendicitis

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