( excellent sensitivity is serum C-react...)Appendicitis: Evolving Tools to Diagnose a Classic Disease,Health

excellent sensitivity is serum C-reactive protein (CRP), a marker of systemic inflammation produced by liver cells. CRP is elevated in many different diseases, but when appendicitis is suspected, a normal CRP has a negative predictive value near 100%. Antibody-based assays are available to determine CRP levels in well under an hour.

Computed tomography (CT) of the abdomen is a mainstay and is particularly helpful if the appendix is visible on the scan. With oral or rectal contrast (with or without intravenous contrast), sensitivity and specificity can both approach 98%. Helical CT, which has finer resolution and shorter acquisition times, has improved test quality and made it more practical for patients who cannot remain still. Another important benefit of CT is that it can reveal diseases other than appendicitis. Unfavorable aspects of CT remain the radiation dose and need for contrast.

Another option is ultrasound, which may be particularly useful for children and has the benefit of no radiation. The test is also readily available. As tradeoffs, ultrasound is less sensitive and specific compared to CT. The test is also operator-dependent.

A new tool to detect appendicitis is the in vivo tracer NeutroSpec (fanolesomab; Mallinckrodt). This mouse antibody binds human CD15, a surface marker for neutrophils as well as eosinophils and some monocytes. When introduced into the blood stream, the antibody attaches to neutrophils, which then travel to the infected appendix. The antibody may also bind portions of neutrophils already at the appendix. Technetium-99m, supplied as a pertechnate and attached to the antibody, serves as a radiolabel to detect antibody as it concentrates in the appendix. This radionuclide has a half-life of approximately 6 hours, and the safety of the radiation dose is well established. A special camera used in nuclear medicine suites can detect the radiolabel and any hyperactivity in the appendix.

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