ArticleAbdominal radiology (New York)2026
Low-keV virtual monoenergetic images with rapid kilovoltage-switching DECT for differentiating complicated from uncomplicated appendicitis in adults.
Article in Abdominal radiology (New York), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
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Who cites it
2 citing papers in PubMed.
- Path beyond the blind end-unravel the imaging spectrum of appendiceal pathologies.Abdominal radiology (New York) · 2026Review
- Appendicolith detection in dual-energy CT of adult acute appendicitis: comparing portovenous phase and virtual noncontrast with true noncontrast images.Abdominal radiology (New York) · 2026Article
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6 authors.
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Abstract
objectivesLow-keV virtual monoenergetic images on dual-energy CT (DECT) enhance iodine attenuation in inflamed appendiceal walls, but the role in differentiating complicated from uncomplicated appendicitis remains unclear. This is particularly relevant given the shift toward nonoperative management of uncomplicated appendicitis.
methodsConsecutive adult patients with pathologically confirmed acute appendicitis who underwent preoperative rapid-kVP-switching DECT and appendectomy within 24 h were retrospectively included. Two radiologists reviewed DECT images, including a finding of appendiceal wall enhancement defects, using three series: 50-keV monoenergetic, 120-kVp-equivalent, and combined series, with discrepancies resolved by a third radiologist. Diagnostic performance of three series for differentiating complicated from uncomplicated appendicitis was assessed. Detection rates of appendiceal wall enhancement defects and radiologist confidence among three series were compared.
resultsAmong 155 patients (50 men, mean age 47.4±19.0 years), 59 had complicated appendicitis. The combined 50-keV/120-kVp-equivalent series provided balanced sensitivity (83.1%) and specificity (86.5%), with an accuracy of 85.2% in differentiating uncomplicated and complicated appendicitis. Although 50-keV images revealed the most wall enhancement defects (48/122; 39.3%), radiologists' confidence was significantly higher using the combined series (91.8% vs. 72.1%, p < 0.001).
conclusionsLow-keV virtual monoenergetic DECT, when combined with 120-kVP-equivalent images, improved the detection of appendiceal wall enhancement defects and increased radiologist confidence in differentiating complicated from uncomplicated appendicitis in adult patients with acute appendicitis.
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