Diagnostic Accuracy of Computed Tomography Features for Acute Appendicitis: A Three-Year Retrospective Cross-Sectional Study at Surat Thani and Wiangsa Crown Prince Hospitals
Keywords:
Appendicitis, Computed tomography, Appendicolith, Appendiceal diameterAbstract
Background: Acute appendicitis is among the most common causes of emergency abdominal surgery. Timely and accurate diagnosis of surgical management is crucial to avoid serious medical complication and reduce the rate of negative appendectomies.
Objective: This study aimed to evaluate the predictive value of four computed tomography (CT) features appendiceal diameter ≥6 mm, wall thickening, periappendiceal fat stranding, and appendicolith in diagnosing acute appendicitis using histopathology as the reference standard. Because the study included only surgically treated patients, diagnostic analysis was restricted to specificity and positive predictive value (PPV). These parameters were calculated to assess the confirmatory role of CT features in clinical practice.
Methods: A retrospective cross-sectional study was conducted at Surat Thani Hospital and Wiangsa Crown Prince Hospital between January 2022 and December 2024. Patients who underwent appendectomy with histopathological confirmation were included. CT scans were reviewed for the four predefined features. Specificity and PPV were calculated for each feature to assess their confirmatory diagnostic value.
Results: A total of 269 patients were analyzed. Appendicolith demonstrated the highest specificity (95.45%) and PPV (97.22%), indicating its strong role as a rule-in feature. Wall thickening (specificity 63.64%, PPV 94.37%) and periappendiceal fat stranding (specificity 45.45%, PPV 93.81%) also showed high PPV despite moderate specificity. Appendiceal diameter ≥6 mm had the lowest specificity (27.27%) but still demonstrated high PPV (93.73%).
Conclusion: CT features provide robust confirmatory value in diagnosing acute appendicitis in surgical patients. Appendicolith, in particular, is highly specific and predictive, while other features offer supportive diagnostic value. Integrating these parameters into diagnostic protocols can improve decision-making, reduce unnecessary appendectomies, lower healthcare costs, and enhance patient outcomes. Future prospective studies including non-operated patients are warranted to enable full evaluation of sensitivity and negative predictive value.
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