A novel reporting system to improve accuracy in appendicitis imaging

Benjamin D. Godwin, Frederick T. Drake, Vlad V. Simianu, Jabi E. Shriki, Daniel S. Hippe, Manjiri Dighe, Sarah Bastawrous, Carlos Cuevas, David Flum, Puneet Bhargava

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


OBJECTIVE. The purpose of this study was to ascertain if standardized radiologic reporting for appendicitis imaging increases diagnostic accuracy. MATERIALS AND METHODS. We developed a standardized appendicitis reporting system that includes objective imaging findings common in appendicitis and a certainty score ranging from 1 (definitely not appendicitis) through 5 (definitely appendicitis). Four radiologists retrospectively reviewed the preoperative CT scans of 96 appendectomy patients using our reporting system. The presence of appendicitis-specific imaging findings and certainty scores were compared with final pathology. These comparisons were summarized using odds ratios (ORs) and the AUC. RESULTS. The appendix was visualized on CT in 89 patients, of whom 71 (80%) had pathologically proven appendicitis. Imaging findings associated with appendicitis included appendiceal diameter (odds ratio [OR] = 14 [> 10 vs < 6 mm]; p = 0.002), periappendiceal fat stranding (OR = 8.9; p < 0.001), and appendiceal mucosal hyperenhancement (OR = 8.7; p < 0.001). Of 35 patients whose initial clinical findings were reported as indeterminate, 28 (80%) had appendicitis. In this initially indeterminate group, using the standardized reporting system, radiologists assigned higher certainty scores (4 or 5) in 21 of the 28 patients with appendicitis (75%) and lower scores (1 or 2) in five of the seven patients without appendicitis (71%) (AUC = 0.90; p = 0.001). CONCLUSION. Standardized reporting and grading of objective imaging findings correlated well with postoperative pathology and may decrease the number of CT findings reported as indeterminate for appendicitis. Prospective evaluation of this reporting system on a cohort of patients with clinically suspected appendicitis is currently under way.

Original languageEnglish (US)
Pages (from-to)1212-1219
Number of pages8
JournalAmerican Journal of Roentgenology
Issue number6
StatePublished - Jun 1 2015

Bibliographical note

Publisher Copyright:
© American Roentgen Ray Society.


  • Appendectomy
  • Appendicitis
  • CT
  • Standardized reporting


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