CT Abdomen and Pelvis CT of the abdomen and pelvis has been shown to provide diagnostic benefit in a mixed population of children and adults with intermediate clinical risk for acute appendicitis where the examination had 90% sensitivity and 95% specificity for acute appendicitis [53]. Because CT covers more anatomic territory than a limited RLQ US, it may identify alternative causes of abdominopelvic pain [54,55]. There are no studies that compare unenhanced and contrast-enhanced CT for diagnosis of acute appendicitis [38,39]. MRI Abdomen and Pelvis Given its high sensitivity and specificity for acute appendicitis, MRI may be indicated in children with an intermediate clinical risk for acute appendicitis [40,41,43]. Similar to CT, the greater anatomic coverage of MRI (versus US) may identify alternative causes of abdominopelvic pain [54,55]. Variant 3: Child. Suspected acute appendicitis, high clinical risk. Initial imaging. Risk stratification for acute appendicitis can be achieved based on overall subjective assessment or use of published scoring systems. The patient-specific likelihood of acute appendicitis among patients classified as high risk varies across the range of high-risk scores and varies between published studies [56]. Approaches to high-risk patients vary in the literature, with some studies using imaging to confirm the diagnosis of appendicitis [49] and other studies advocating surgical intervention without imaging based on a demonstrated high accuracy of the scoring system in their practice [13,17,18,48,57]. Radiography Abdomen Radiographs are neither sensitive nor specific for a diagnosis of acute appendicitis but may aid in terms of excluding complications of acute appendicitis, such as bowel obstruction or gross perforation [51]. US Abdomen RLQ There is no evidence to support routine US in all patients considered high risk for acute appendicitis.
Suspected Appendicitis Child. CT Abdomen and Pelvis CT of the abdomen and pelvis has been shown to provide diagnostic benefit in a mixed population of children and adults with intermediate clinical risk for acute appendicitis where the examination had 90% sensitivity and 95% specificity for acute appendicitis [53]. Because CT covers more anatomic territory than a limited RLQ US, it may identify alternative causes of abdominopelvic pain [54,55]. There are no studies that compare unenhanced and contrast-enhanced CT for diagnosis of acute appendicitis [38,39]. MRI Abdomen and Pelvis Given its high sensitivity and specificity for acute appendicitis, MRI may be indicated in children with an intermediate clinical risk for acute appendicitis [40,41,43]. Similar to CT, the greater anatomic coverage of MRI (versus US) may identify alternative causes of abdominopelvic pain [54,55]. Variant 3: Child. Suspected acute appendicitis, high clinical risk. Initial imaging. Risk stratification for acute appendicitis can be achieved based on overall subjective assessment or use of published scoring systems. The patient-specific likelihood of acute appendicitis among patients classified as high risk varies across the range of high-risk scores and varies between published studies [56]. Approaches to high-risk patients vary in the literature, with some studies using imaging to confirm the diagnosis of appendicitis [49] and other studies advocating surgical intervention without imaging based on a demonstrated high accuracy of the scoring system in their practice [13,17,18,48,57]. Radiography Abdomen Radiographs are neither sensitive nor specific for a diagnosis of acute appendicitis but may aid in terms of excluding complications of acute appendicitis, such as bowel obstruction or gross perforation [51]. US Abdomen RLQ There is no evidence to support routine US in all patients considered high risk for acute appendicitis.