Low-Dose Abdominal CT for Evaluating Suspected Appendicitis in Adolescents and Young Adults: Review of Evidence

Abstract

Due to its excellent diagnostic performance, CT is the mainstay of diagnostic test in adults with suspected acute appendicitis in many countries. Although debatable, extensive epidemiological studies have suggested that CT radiation is carcinogenic, at least in children and adolescents. Setting aside the debate over the carcinogenic risk of CT radiation, the value of judicious use of CT radiation cannot be overstated for the diagnosis of appendicitis, considering that appendicitis is a very common disease, and that the vast majority of patients with suspected acute appendicitis are adolescents and young adults with average life expectancies. Given the accumulated evidence justifying the use of low-dose CT (LDCT) of only 2 mSv, there is no reasonable basis to insist on using radiation dose of multi-purpose abdominal CT for the diagnosis of appendicitis, particularly in adolescents and young adults. Published data strongly suggest that LDCT is comparable to conventional dose CT in terms of clinical outcomes and diagnostic performance. In this narrative review, we will discuss such evidence for reducing CT radiation in adolescents and young adults with suspected appendicitis.

Keywords: Appendicitis; Evidence-based practice; Multidetector computed tomography; Radiation dosage.

Fig. 1. A 38-year-old female with right lower quadrant pain.

A, B. Contrast-enhanced transverse (A) and coronal (B) low-dose CT images show an appendiceal wall defect (arrows) at the inflamed appendix (arrowheads) and periappendiceal fat infiltration (curved arrows). Perforation was confirmed both surgically and pathologically.

Fig. 2. A 21-year-old female with right lower quadrant pain.

A, B. Contrast-enhanced transverse (A) and coronal (B) low-dose CT images clearly show the normal appendix (arrows) in the abundant periappendiceal fat. The effective dose of the CT scan was 3 mSv, which was adjusted to the body size (body-mass index, 33.5 kg/m²) through automatic exposure control.