Original Article
Usefulness of Computed Tomography Findings in Guiding Surgical Decisions for Acute Appendicitis in Adults: A Systematic Review
2026 年 12 巻 2 号 p. 36-45
詳細
2026 年 12 巻 2 号 p. 36-45
Introduction: Acute appendicitis is generally managed either surgically by appendectomy or non-surgically with antibiotics. The therapeutic strategy is mainly determined by the presence of clinical or computed tomography (CT) findings suggestive of gangrenous appendicitis or perforation. Although several systematic reviews have evaluated the diagnostic utility of contrast-enhanced CT in complicated appendicitis, none have focused exclusively on plain CT. In this study, we aimed to assess the usefulness of 5 findings detectable on plain CT for determining surgical indications in adults with acute appendicitis.
Methods: A PubMed search identified studies published between 2015 and 2024 using the keywords "acute appendicitis," "diagnosis," and "CT." Case reports, pediatric and pregnant populations, low-dose CT studies, abstracts only, and studies with fewer than 100 participants were excluded. Seventeen articles (6 on CT diagnostic accuracy and 11 on appendiceal findings) were included.
Results: Regarding complicated appendicitis, pooled sensitivity, specificity, and accuracy were 94.2%, 88.9%, and 91.8% for contrast-enhanced CT, and 88.7%, 86.4%, and 87.6% for plain CT, respectively. The diagnostic accuracies of 5 detectable on plain CT were as follows: appendicolith (50.7%, 74.2%, 66.3%), periappendiceal fat stranding (91.6%, 30.3%, 54.2%), enlarged appendiceal diameter (54.3%, 66.9%, 61.7%), periappendiceal air (22.4%, 99.0%, 70.3%), and periappendiceal fluid collection (61.4%, 57.6%, 59.0%).
Conclusions: Each of the 5 findings detectable on plain CT is insufficient as a standalone criterion for determining surgical indication; however, the combined assessment of selected findings-particularly appendicolith characteristics, periappendiceal fat stranding, and periappendiceal air-might substantially improve identification of complicated appendicitis. These findings may be particularly useful when contrast-enhanced CT is contraindicated.
