Mark Nicholls reports on the CT v. US debate
A growing number of Dutch hospital doctors now favour ultrasound (US) over CT scans to detect appendicitis in children. This trend has re-opened the US v. CT debate over which diagnostic method is more effective, cost-effective and safest for a child's longer-term health needs.
In recent years she has examined at the two methods and established clear classifications for diagnosing appendicitis using US. If the appendix is seen and is normal, or if it is not visualised but with no secondary signs of appendicitis, then there is no appendicitis,’ she explained. However, if the appendix is seen, and is enlarged and has signs of inflammation, or if the appendix is not seen, but there are secondary signs of appendicitis, then there is appendicitis.
Secondary signs include increased echogenicity of the appendix’ surrounding area, suggesting inflammation of mesenteric fat; local fluid collection suggesting an appendicular abscess; or local dilatation of the thin bowel without peristalsis indicating focal peritonitis, she explained, adding that, if they are present - without visualisation of the appendix – the diagnosis of appendicitis is very likely.
Graded compression of the appendix with US can be painful, she agreed, but is generally well tolerated by all children.
US is also cheaper than CT. An ultrasound examination in the Netherlands costs around ?80, compared with ?300 for CT. More CT scans can be performed in an hour, but an ultrasound scanner is relatively maintenance-free.
Child adiposity potentially makes US more difficult to perform, she also added. This is a lesser issue in Europe than in the USA, where legal issues are more significant, so CT may be preferred because it is better documented than ultrasound.
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