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Evaluation of the Maximum Depth of Intraluminal Appendiceal Fluid to Diagnose Appendicitis With a 64–Detector Row CT Scanner

Moteki, Takao MD*; Ohya, Nariyuki MD; Horikoshi, Hiroyuki MD

Journal of Computer Assisted Tomography: November/December 2011 - Volume 35 - Issue 6 - p 703–710
doi: 10.1097/RCT.0b013e3182324443
Original Article

Objective The objective of this study was to investigate whether the criterion “maximum depth of intraluminal appendiceal fluid greater than 2.6 mm” (“DEPTH >2.6 mm”), with the use of 64–detector row computed tomography, is useful to diagnose appendicitis.

Methods We retrospectively evaluated 0.68-mm-thick images of 2894 intravenously enhanced abdominal-pelvic computed tomography using the following criteria: (1) appendiceal wall thickness greater than 3 mm, (2) appendiceal wall enhancement, (3) focal cecal wall thickening, (4) adjacent lymphadenopathy greater than 5 mm, (5) appendicolith, (6) periappendiceal inflammation, and (7) the new criterion, DEPTH >2.6 mm. Of the 2894 images, 1013 were classified into normal group (including 622 distended [diameter >6 mm] but normal appendices without adjacent lesions), modified group (235 distended normal appendices modified with adjacent lesions), proven-appendicitis group (82 operatively proven appendicitis cases), and clinical-appendicitis group (62 clinically certified appendicitis cases).

Results The new criterion, DEPTH >2.6 mm, demonstrated both higher sensitivities and higher specificities in all groups (>90%), although this criterion showed lower specificities than some conventional criteria. In contrast, conventional criteria showed lower sensitivities or lower specificities (<60%) in one or more of these groups.

Conclusions DEPTH >2.6 mm is particularly useful for differentiating appendicitis from distended normal appendix.

From the *Department of Radiology, Fujioka General Hospital, Fujioka, Fujiokashi, Gunma, Japan; and †Department of Radiology, Gunma Cancer Tomo Hospital, Takabayashinishi-machi, Otashi, Gunma, Japan.

Received for publication February 11, 2011; accepted July 26, 2011.

Reprints: Takao Moteki, MD, Department of Radiology, Fujioka General Hospital, 942-1, Fujioka, Fujiokashi, Gunma 375-8503, Japan (e-mail:

No funding was received for this work.

The authors have no conflicts of interest.

© 2011 Lippincott Williams & Wilkins, Inc.