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January 20, 2021

Optimizing the Gold Standard—Low-Dose Computed Tomography Modalities as a Part of Clinical Practice in Acute Appendicitis Imaging

Author Affiliations
  • 1Division of Digestive Surgery and Urology, Turku University Hospital, Turku, Finland
  • 2Department of Surgery, University of Turku, Turku, Finland
  • 3Department of Surgery, Satasairaala Central Hospital, Pori, Finland
JAMA Surg. 2021;156(4):351-352. doi:10.1001/jamasurg.2020.6358

Suspicion of appendicitis is globally one of the most common reasons for emergency surgical visits, with appendectomy as the standard treatment for all appendicitis cases for more than a century, even though both epidemiological and clinical data have shown uncomplicated and complicated acute appendicitis being distinct entities instead of consecutive events. Antibiotics are shown to be a safe and efficient alternative to appendectomy for patients with imaging-confirmed, uncomplicated appendicitis, both in adults1 and children,2 setting new standards for preinterventional appendicitis diagnostics and shifting the emphasis from solely assessing the presence of appendicitis toward distinguishing between uncomplicated and complicated appendicitis with high accuracy. This requires imaging, with computed tomography (CT) being the gold standard in adults. However, the main disadvantage of CT is exposure to radiation. The high appendicitis incidence in adolescents and young adults more sensitive to the late effects of radiation emphasizes the need to reduce the CT dose.

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