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Helical Computed Tomography in Differentiating Appendicitis and Acute Gynecologic Conditions

From the Departments of Radiology, Obstetrics and Gynecology, and Surgery, Massachusetts General Hospital, Boston, Massachusetts.

Address reprint requests to: Patrick M. Rao, MD, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, E-mail: rao.patrick{at}mgh.harvard

Objective: To determine the accuracy and effect of helical computed tomography (CT) in women clinically suspected of having either appendicitis or an acute gynecologic condition.

Methods: One hundred consecutive nonpregnant women suspected of having appendicitis or an acute gynecologic condition prospectively had helical CT. Interpretations were correlated with surgical and pathologic findings (41 cases) and clinical follow-up for at least 2 months (59 cases). The accuracy for confirming or excluding both appendicitis and acute gynecologic conditions was determined. The effect on patient care was determined by comparing pre-CT plans with actual treatment.

Results: Thirty-two women had appendicitis, 15 had acute gynecologic conditions, 27 had other specific diagnoses, and 26 had nonspecific abdominal pain. For diagnosing appendicitis or acute gynecologic conditions, CT had 100% and 87% sensitivity, 97% and 100% specificity, 94% and 100% positive predictive value, 100% and 98% negative predictive value, and 98% and 98% accuracy, respectively. After CT was done, 36 planned hospital admissions, 25 planned hospital observations, and six planned appendectomies were deferred; six women had alternative surgical procedures on the basis of CT results. One patient had an unnecessary appendectomy on the basis of CT findings.

Conclusion: Helical CT is an excellent imaging option for differentiating appendicitis from most acute gynecologic conditions.

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