Is Contrast Needed for CT Diagnosis of Acute Appendicitis?

The diagnosis of acute appendicitis often is made with contrast-enhanced abdominal computed tomography (CT) scan, despite mixed evidence that contrast is needed. Contrast-enhanced CT is associated with potential risks from the contrast material (e.g., renal toxicity, allergic reaction) and requires substantially more time than unenhanced CT.

These authors conducted a comprehensive systematic review of the literature to determine the accuracy of unenhanced helical CT for diagnosing acute appendicitis in adult patients with abdominal pain. The reference standard was the final diagnosis at surgery or follow-up. Seven studies that provided data for 1060 patients met the inclusion criteria. Pooled estimates for sensitivity and specificity of unen…