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Imaging of Acute Appendicitis in Children: Computed Tomography Including Radiation Issues

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Imaging of Acute Appendicitis in Adults and Children

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

Clinical presentation, along with careful diagnostic imaging, should be employed when appendicitis is suspected in a child. Because computed tomography (CT) is becoming increasingly utilized for the diagnosis of acute appendicitis in children, radiologists must carefully and responsibly consider the issue of radiation exposure.

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Abbreviations

CT:

Computed tomography

ALARA:

As low as reasonably achievable

References

  • Acosta R, Crain EF, Goldman HS (2005) CT can reduce hospitalization for observation in children with suspected appendicitis. Pediatr Radiol 35(5):495–500

    Article  PubMed  Google Scholar 

  • Aldrich JE et al (2006) Radiation dose in abdominal computed tomography: the role of patient size and the selection of tube current. Can Assoc Radiol J 57(3):152–158

    PubMed  Google Scholar 

  • Applegate KE et al (2001) Effect of cross-sectional imaging on negative appendectomy and perforation rates in children. Radiology 220(1):103–107

    PubMed  CAS  Google Scholar 

  • Arch ME, Frush DP (2008) Pediatric body MDCT: a 5-year follow-up survey of scanning parameters used by pediatric radiologists. AJR Am J Roentgenol 191(2):611–617

    Article  PubMed  Google Scholar 

  • Bennett GL, Slywotzky CM, Giovanniello G (2002) Gynecologic causes of acute pelvic pain: spectrum of CT findings. Radiographics 22(4):785–801

    PubMed  Google Scholar 

  • Birnbaum BA, Wilson SR (2000) Appendicitis at the millennium. Radiology 215(2):337–348

    PubMed  CAS  Google Scholar 

  • Brenner D et al (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176(2):289–296

    PubMed  CAS  Google Scholar 

  • Brenner DJ et al (2003) Cancer risks attributable to low doses of ionizing radiation: assessing what we really know. Proc Natl Acad Sci USA 100(24):13761–13766

    Article  PubMed  CAS  Google Scholar 

  • Brenner DJ (2002) Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol 32(4):228–231 (discussion 242–244)

    Google Scholar 

  • Brenner DJ, Hall EJ (2007) Computed tomography—an increasing source of radiation exposure. N Engl J Med 357(22):2277–2284

    Article  PubMed  CAS  Google Scholar 

  • Brown JJ (1991) Acute appendicitis: the radiologist’s role. Radiology 180(1):13–14

    PubMed  CAS  Google Scholar 

  • Callahan MJ, Rodriguez DP, Taylor GA (2002) CT of appendicitis in children. Radiology 224(2):325–332

    Article  PubMed  Google Scholar 

  • Carty HM (2002) Paediatric emergencies: non-traumatic abdominal emergencies. Eur Radiol 12(12):2835–2848

    PubMed  CAS  Google Scholar 

  • Charles MW (2003) Studies of mortality of atomic bomb survivors. Report 13: solid cancer and noncancer disease mortality: 1950–1997. J Radiol Prot 23(4):457–459

    Google Scholar 

  • Choi D et al (2003) The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT. Acta Radiol 44(6):574–582

    PubMed  CAS  Google Scholar 

  • Cody DD (2002) AAPM/RSNA physics tutorial for residents: topics in CT. Image processing in CT. Radiographics 22(5):1255–1268

    PubMed  Google Scholar 

  • Doria AS et al (2006) US or CT for diagnosis of appendicitis in children and adults? a meta-analysis. Radiology 241(1):83–94

    Article  PubMed  Google Scholar 

  • Fisher JD, Reeves JJ (2004) Presentation variability of acute urolithiasis in school-aged children. Am J Emerg Med 22(2):108–110

    Article  PubMed  Google Scholar 

  • Flum DR, Koepsell T (2002) The clinical and economic correlates of misdiagnosed appendicitis: nationwide analysis. Arch Surg 137(7):799–804 (discussion 804)

    Google Scholar 

  • Frei SP et al (2008) Appendicitis outcomes with increasing computed tomographic scanning. Am J Emerg Med 26(1):39–44

    Article  PubMed  Google Scholar 

  • Frush DP, Applegate K (2004) Computed tomography and radiation: understanding the issues. J Am Coll Radiol 1(2):113–119

    Article  PubMed  Google Scholar 

  • Frush DP, Donnelly LF (1998) Helical CT in children: technical considerations and body applications. Radiology 209(1):37–48

    PubMed  CAS  Google Scholar 

  • Gaitini D et al (2008) Diagnosing acute appendicitis in adults: accuracy of color doppler sonography and MDCT compared with surgery and clinical follow-up. AJR Am J Roentgenol 190(5):1300–1306

    Article  PubMed  Google Scholar 

  • Garcia Pena BM et al (1999) Ultrasonography and limited computed tomography in the diagnosis and management of appendicitis in children. JAMA 282(11):1041–1046

    Article  PubMed  CAS  Google Scholar 

  • Goske MJ et al (2008) The Image Gently campaign: working together to change practice. AJR Am J Roentgenol 190(2):273–274

    Article  PubMed  Google Scholar 

  • Goske MJ, Frush DP, Schauer DA (2009) Image Gently campaign promotes radiation protection for children. Radiat Prot Dosimetry 135(4):276

    Article  PubMed  Google Scholar 

  • Grattan-Smith JD, Blews DE, Brand T (2002) Omental infarction in pediatric patients: sonographic and CT findings. AJR Am J Roentgenol 178(6):1537–1539

    PubMed  Google Scholar 

  • Hall EJ (2002) Lessons we have learned from our children: cancer risks from diagnostic radiology. Pediatr Radiol 32(10):700–706

    Article  PubMed  Google Scholar 

  • Helmrath MA et al (2001) Right lower quadrant pain in children caused by omental infarction. Am J Surg 182(6):729–732

    Article  PubMed  CAS  Google Scholar 

  • Hernanz-Schulman M (2010) CT and US in the diagnosis of appendicitis: an argument for CT. Radiology 255(1):3–7

    Article  PubMed  Google Scholar 

  • Horrow MM, White DS, Horrow JC (2003) Differentiation of perforated from nonperforated appendicitis at CT. Radiology 227(1):46–51

    Article  PubMed  Google Scholar 

  • Huda W et al (1997) An approach for the estimation of effective radiation dose at CT in pediatric patients. Radiology 203(2):417–422

    PubMed  CAS  Google Scholar 

  • IMV (2006) CT market Summary Report. Available fromhttp://www.imvinfo.com/user/documents/content_documents/nws_rad/MS_CT_DSandTOC.pdf. Cited 12 July 2010

  • Johansson EP, Rydh A, Riklund KA (2007) Ultrasound computed tomography, and laboratory findings in the diagnosis of appendicitis. Acta Radiologica 48(3):267–273

    Article  PubMed  CAS  Google Scholar 

  • Jones K et al (2004) Are negative appendectomies still acceptable? Am J Surg 188(6):748–754

    Article  PubMed  Google Scholar 

  • Kaiser S et al (2004) Impact of radiologic imaging on the surgical decision-making process in suspected appendicitis in children. Acad Radiol 11(9):971–979

    Article  PubMed  Google Scholar 

  • Kaiser S, Frenckner B, Jorulf HK (2002) Suspected appendicitis in children: US and CT—a prospective randomized study. Radiology 223(3):633–638

    Article  PubMed  Google Scholar 

  • Kalra MK et al (2004) Techniques and applications of automatic tube current modulation for CT. Radiology 233(3):649–657

    Article  PubMed  Google Scholar 

  • Kharbanda AB, Taylor GA, Bachur RG (2007) Suspected appendicitis in children: rectal and intravenous contrast-enhanced versus intravenous contrast-enhanced CT. Radiology 243(2):520–526

    Article  PubMed  Google Scholar 

  • Koumanidou C et al (2002) Sonographic detection of lymph nodes in the intussusception of infants and young children: clinical evaluation and hydrostatic reduction. AJR Am J Roentgenol 178(2):445–450

    PubMed  CAS  Google Scholar 

  • Lameris W et al (2009) Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. BMJ 338:b2431

    Article  PubMed  Google Scholar 

  • Lowe LH et al (2000) Appendicolith revealed on CT in children with suspected appendicitis: how specific is it in the diagnosis of appendicitis? AJR Am J Roentgenol 175(4):981–984

    PubMed  CAS  Google Scholar 

  • Lowe LH et al (2001a) Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography. AJR Am J Roentgenol 176(1):31–35

    PubMed  CAS  Google Scholar 

  • Lowe LH et al (2001b) Nonenhanced limited CT in children suspected of having appendicitis: prospective comparison of attending and resident interpretations. Radiology 221(3):755–759

    Article  PubMed  CAS  Google Scholar 

  • Lowe LH et al (2001c) Appendicitis and alternate diagnoses in children: findings on unenhanced limited helical CT. Pediatr Radiol 31(8):569–577

    Article  PubMed  CAS  Google Scholar 

  • Macari M et al (2002) Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. AJR Am J Roentgenol 178(4):853–858

    PubMed  Google Scholar 

  • Martin AE et al (2004) CT scans may not reduce the negative appendectomy rate in children. J Pediatr Surg 39(6) 886–890 (discussion 886–890)

    Google Scholar 

  • McCollough CH, Bruesewitz MR, Kofler JM Jr (2006) CT dose reduction and dose management tools: overview of available options. Radiographics 26(2):503–512

    Article  PubMed  Google Scholar 

  • Menes TS et al (2006) Increased use of computed tomography does not harm patients with acute appendicitis. Am Surg 72(4):326–329

    PubMed  Google Scholar 

  • Mettler FA Jr et al (2000) CT scanning: patterns of use and dose. J Radiol Prot 20(4):353–359

    Article  PubMed  Google Scholar 

  • Mettler FA Jr et al (2009) Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources—1950–2007. Radiology 253(2):520–531

    Google Scholar 

  • Moore C et al (2009) Prevalence of abnormal CT findings in patients with proven ovarian torsion and a proposed triage schema. Emerg Radiol 16(2):115–120

    Article  PubMed  Google Scholar 

  • Mountford PJ, Temperton DH (1992) Recommendations of the international commission on radiological protection (ICRP) 1990. Eur J Nuc Med 19(2):77–79

    Google Scholar 

  • Nagar H et al (2003) Omental infarction: an unusual cause of acute abdomen in children. Pediatr Surg Int 19(9–10):677–679

    Article  PubMed  CAS  Google Scholar 

  • Pena BM et al (2000) Costs and effectiveness of ultrasonography and limited computed tomography for diagnosing appendicitis in children. Pediatrics 106(4):672–676

    Article  PubMed  CAS  Google Scholar 

  • Puig S et al (2008) Imaging of appendicitis in children and adolescents: useful or useless? A comparison of imaging techniques and a critical review of the current literature. Semin Roentgenol 43(1):22–28

    Article  PubMed  Google Scholar 

  • Puylaert JB, van der Zant FM, Rijke AM (1997) Sonography and the acute abdomen: practical considerations. AJR Am J Roentgenol 168(1):179–186

    PubMed  CAS  Google Scholar 

  • Raman SS et al (2008) Effect of CT on false positive diagnosis of appendicitis and perforation. N Engl J Med 358(9):972–973

    Article  PubMed  CAS  Google Scholar 

  • Rao PM et al (1997) Appendicitis: use of arrowhead sign for diagnosis at CT. Radiology 202(2):363–366

    PubMed  CAS  Google Scholar 

  • Rao PM et al (1999) Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 229(3):344–349

    Article  PubMed  CAS  Google Scholar 

  • Rao PM, Rhea JT, Novelline RA (1997) Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 21(5):686–692

    Article  PubMed  CAS  Google Scholar 

  • Rettenbacher T et al (2000) Presence or absence of gas in the appendix: additional criteria to rule out or confirm acute appendicitis–evaluation with US. Radiology 214(1):183–187

    PubMed  CAS  Google Scholar 

  • Rodriguez DP et al (2006) Appendicitis in young children: imaging experience and clinical outcomes. AJR Am J Roentgenol 186(4):1158–1164

    Article  PubMed  Google Scholar 

  • Rosendahl K, Aukland SM, Fosse K (2004) Imaging strategies in children with suspected appendicitis. Eur Radiol 14(Suppl 4):L138–L145

    PubMed  Google Scholar 

  • Ruess L et al (2000) Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment. AJR Am J Roentgenol 175(1):79–84

    PubMed  CAS  Google Scholar 

  • Siegel MJ (1992) Acute appendicitis in childhood: the role of US. Radiology 185(2):341–342

    PubMed  CAS  Google Scholar 

  • Sivit CJ et al (2000) Imaging evaluation of suspected appendicitis in a pediatric population: effectiveness of sonography versus CT. AJR Am J Roentgenol 175(4):977–980

    PubMed  CAS  Google Scholar 

  • Sivit CJ (2004) Imaging the child with right lower quadrant pain and suspected appendicitis: current concepts. Pediatr Radiol 34(6):447–453

    Article  PubMed  Google Scholar 

  • Sivit CJ, Applegate KE (2003) Imaging of acute appendicitis in children. Semin Ultrasound CT MR 24(2):74–82

    Article  PubMed  Google Scholar 

  • Sivit CJ et al (2001) When appendicitis is suspected in children. Radiographics 21(1):247–262 (questionnaire 288–294)

    Google Scholar 

  • Stephen AE et al (2003) The diagnosis of acute appendicitis in a pediatric population: to CT or not to CT. J Pediatr Surg 38(3):367–371 (discsussion 367–371)

    Google Scholar 

  • Strauss KJ et al (2010) Image gently: Ten steps you can take to optimize image quality and lower CT dose for pediatric patients. AJR Am J Roentgenol 194(4):868–873

    Article  PubMed  Google Scholar 

  • Sturm EJ et al (2004) Detection of ileocecal Crohn’s disease using ultrasound as the primary imaging modality. Eur Radiol 14(5):778–782

    Article  PubMed  CAS  Google Scholar 

  • Taylor GA et al (2006) CT for suspected appendicitis in children: an analysis of diagnostic errors. Pediatr Radiol 36(4):331–337

    Article  PubMed  Google Scholar 

  • Teo EL et al (2000) Ultrasonography and computed tomography in a clinical algorithm for the evaluation of suspected acute appendicitis in children. Singapore Med J 41(8):387–392

    PubMed  CAS  Google Scholar 

  • Thomas KE, Wang B (2008) Age-specific effective doses for pediatric MSCT examinations at a large children’s hospital using DLP conversion coefficients: a simple estimation method. Pediatr Radiol 38(6):645–656

    Article  PubMed  Google Scholar 

  • Townsend BA, Callahan MJ, Zuralowski D, Taylor GA (2010) Has the use of pediatric CT at children’s hospitals reached its peak? Am J Roentgenol 194:1194–31196

    Article  Google Scholar 

  • van Breda Vriesman AC, Puylaert JB (2006) Mimics of appendicitis: alternative nonsurgical diagnoses with sonography and CT. AJR Am J Roentgenol 186(4):1103–1112

    Article  PubMed  Google Scholar 

  • van Randen A et al (2008) Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 249(1):97–106

    Article  PubMed  Google Scholar 

  • Varjavandi V et al (2003) Omental infarction: risk factors in children. J Pediatr Surg 38(2):233–235

    Article  PubMed  Google Scholar 

  • Vermeulen B et al (1999) Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate—a randomized trial. Radiology 210(3):639–643

    PubMed  CAS  Google Scholar 

  • Voss SD et al (2009) The ALARA concept in pediatric oncology. Pediatr Radiol 39(11):1142–1146

    Article  PubMed  Google Scholar 

  • Weltman DI et al (2000) Diagnosis of acute appendicitis: comparison of 5- and 10-mm CT sections in the same patient. Radiology 216(1):172–177

    PubMed  CAS  Google Scholar 

  • Yeung KW, Chang MS, Hsiao CP (2004) Evaluation of perforated and nonperforated appendicitis with CT. Clin Imaging 28(6):422–427

    Article  PubMed  Google Scholar 

  • Yu J et al (2005a) Helical CT evaluation of acute right lower quadrant pain: part I, common mimics of appendicitis. AJR Am J Roentgenol 184(4):1136–1142

    PubMed  Google Scholar 

  • Yu J et al (2005b) Helical CT evaluation of acute right lower quadrant pain: part II, uncommon mimics of appendicitis. AJR Am J Roentgenol 184(4):1143–1149

    PubMed  Google Scholar 

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Authors and Affiliations

  1. School of Medicine, University of Missouri-Kansas City, Red 1, 2411 Holmes Street, Kansas City, MO, 64108, USA

    Andrew J. Spencer, Megan R. Saettele & Lisa H. Lowe

  2. Department of Radiology, St. Luke’s Hospital, University of Missouri-Kansas City, 4401 Wornall Road, Kansas City, MO, 64111, USA

    Megan R. Saettele

  3. Department of Radiology, Children’s Mercy Hospitals and Clinics, University of Missouri-Kansas City, 2401 Gillham Road, Kansas City, MO, 64108, USA

    Lisa H. Lowe

Authors
  1. Andrew J. Spencer
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  2. Megan R. Saettele
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  3. Lisa H. Lowe
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Correspondence to Andrew J. Spencer .

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Editors and Affiliations

  1. , Radiology, Hôpital Erasme, Route de Lennik 808, Brussels, 1070, Belgium

    Caroline KEYZER

  2. Hôspital Erasme, Department of Radiology, Université libre de Bruxelles, Route de Lennik 808, Brussels, 1070, Belgium

    Pierre Alain Gevenois

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Spencer, A.J., Saettele, M.R., Lowe, L.H. (2012). Imaging of Acute Appendicitis in Children: Computed Tomography Including Radiation Issues. In: KEYZER, C., Gevenois, P. (eds) Imaging of Acute Appendicitis in Adults and Children. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_226

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