Role of focused appendiceal computed tomography in clinically equivocal acute appendicitis

Objective: To determine the accuracy of FACT (focused appendiceal computed tomography) in evaluation of acute appendicitis. Methods: The study was conducted in Aga Khan University Hospital, Karachi, over a period of one year. Sixty-three patients with clinically equivocal acute appendicitis underwent thin-section non-enhanced helical CT. Axial scans were obtained in a single breath hold from L2 vertebral level to the pubic symphysis with 5-mm collimation and a pitch of 1.5. All scans were obtained without oral, intravenous, or rectal contrast material. Criteria for diagnosis of acute appendicitis included an enlarged appendix (>6 mm diameter) and periappendiceal inflammation. Final diagnoses were established with the results of surgical or clinical follow-up. Results: There were 21 true-positive diagnoses, 38 true-negative diagnoses, no false-positive diagnoses, and 2 false-negative diagnoses, which yielded a sensitivity of 91% and a specificity of 100%. Conclusion: Non-enhanced FACT is a highly accurate problem solving technique in clinically equivocal cases of acute appendicitis.