Using unenhanced helical CT with enteric contrast material for suspected appendicitis in patients treated at a community hospital.

OBJECTIVE: We evaluated the accuracy of unenhanced helical CT with enteric contrast material in the diagnosis of appendicitis in children and adults treated at a community hospital. SUBJECTS AND METHODS: Over an 8-month period, 100 consecutive patients with right lower quadrant pain and suspected appendicitis were prospectively evaluated. Thin-collimation helical CT scanning was performed after administration of enteric contrast material. CT interpretations were correlated with surgical pathology (45 patients) and clinical follow-up (55 patients). RESULTS: The findings of 33 CT scans were interpreted as positive for appendicitis (29 true-positives and four false-positives), and the findings of 67 were interpreted as negative for appendicitis (66 true-negatives and one false-negative). Sensitivity was 97%, specificity was 94%, accuracy was 95%, positive predictive value was 88%, and negative predictive value was 99%. In the 67 CT scans with negative findings for appendicitis, an alternative diagnosis was made for 36 patients (54%). CONCLUSION: Unenhanced helical CT with enteric contrast material for the evaluation of appendicitis can be implemented in a community hospital. In our study, such imaging achieved excellent accuracy.

Computed tomography in the headache patient: is routine evaluation really necessary?

OBJECTIVE: To determine the likelihood ratio of a positive computed tomogram of the brain in the routine evaluation of headache patients. DESIGN: Consecutive patients with a chief complaint of headache were prospectively evaluated with computed tomography of the brain. Patients with headaches complicating other clinical disorders such as trauma, postictal state or known intracranial neoplasm were excluded. SETTING: Military tertiary care center. PATIENTS: Consecutive sample of 350 patients with a chief complaint of headache, regardless of the presence or absence of physical or neurologic signs, were referred for computed tomography of the brain. The patients were referred from a variety of inpatient and outpatient settings. RESULTS: Seven (2%) of the 350 patients had computed tomographic findings that were clinically significant. An additional 25 (7%) had positive computed tomographic findings, which were clinically insignificant for findings. All of the patients with significant computed tomographic findings had an abnormal physical or neurologic exam or unusual clinical symptoms. CONCLUSION: Routine computed tomography of the brain in headache patients with normal physical and neurologic exams and no unusual clinical symptoms has a low likelihood ratio for discovering significant intracranial disease.

CT of the normal appendix.

We conducted a prospective evaluation of the normal vermiform appendix in 203 patients. Conventional CT techniques were utilized with an 8 mm slice thickness and 10 mm slice interval. The normal appendix was definitely identified in 51% of the patients studied. Computed tomographic appearance of the normal appendix is demonstrated, and potential pitfalls are described.

Computed tomography of the brain in the evaluation of the headache patient.

A retrospective analysis was conducted of 100 consecutive patients evaluated with computerized tomography of the head who had the chief complaint of headache. Three percent of these patients had abnormal findings, which were clinically significant in terms of patient treatment and follow-up. An additional 10% had computed tomography findings, which were clinically insignificant in that they did not alter the patient's treatment or clinical course. All of the significant findings occurred in patients who were age 45 years or older. In the 85 patients who were less than age 45, no significant abnormalities were found.