Appendicitis: efficacy of color Doppler sonography

PURPOSE: To determine whether the addition of color Doppler ultrasonography (US) to gray-scale US can help diagnose appendicitis in children.

MATERIALS AND METHODS: One hundred children with suspected appendicitis were evaluated with gray-scale and color Doppler US scanning. Color Doppler US scans were considered positive for appendicitis if increased vascularity was demonstrated in the appendiceal wall and positive for perforation with abscess if a hyperemic right lower quadrant mass was seen. Gray-scale US was positive for appendicitis if a blind-ending, noncompressible appendix larger than 6 mm in diameter, a loculated periappendiceal mass, or both were identified.

RESULTS: Thirty-nine patients had acute appendicitis; 26 had uncomplicated appendicitis, and 13 had perforation. Acute appendicitis was identified in 34 of 39 patients (87%) on color Doppler US scans with a sensitivity of 87%, specificity of 97%, and accuracy of 93%. Gray-scale US sensitivity was 87%; specificity, 92%; and accuracy, 90%.

CONCLUSION: Blood flow in the appendiceal wall or right lower quadrant mass on color Doppler US scans suggests appendicitis, but absence of flow cannot definitively distinguish a normal from an abnormal appendix.