Role of Duplex Doppler in Accurate Diagnosis of Appendicitis
Role of Duplex Doppler in Accurate Diagnosis of Appendicitis
To evaluate the role of duplex doppler in diagnosis of appendicitis compared to CT
Acute appendicitis (AA) is the most common acute abdominal condition worldwide [1]

 Thus far, the clinical diagnosis of (AA) remains a challenge to emergency physicians and
 surgeons both in the pediatric and adult populations, as the symptoms are often atypical and
 overlapped with various other diseases[2],[3].

 The accurate diagnosis of AA depends on both clinical presentations and imaging techniques.

 To date, US and computed tomography (CT) remain the most common used diagnostic imaging, and
 CT is considered the gold standard technique to evaluate patients with suspected AA, because
 of its high sensitivity and specificity [2],[3]. While the associated radiation exposure
 remains a concern, especially, among children, the elderly and pregnant women, as radiation
 protection is of major importance [2],[3],[5],[6].

 Over recent years, research on various aspects of US imaging in the diagnosis of (AA) has
 gained major importance due to its radiation protection, broad availability and
 cost-effectiveness [6].

 Therefore,US may be valuable as an initial imaging choice for patients with suspected (AA) or
 with equivocal clinical presentations [7],[8].

 With continuing efforts to improve the diagnostic performance of US, a variety of US findings
 have been described for use in the setting of suspected appendicitis, including the maximum
 outer diameter (MOD), periappendiceal fluid, echogenic periappendiceal fat, and loss of the
 normally echogenic submucosal layer within the appendiceal wall [9] ,[10].

 Color Doppler imaging has been utilized as well, with early reports describing no detectable
 flow in the normal appendix and later reports, with the benefit of improved instrumentation,
 d describing flow in normal appendices and hyperemia in inflamed appendices [11],[12].

 However, objective criteria for interpreting Doppler results generally have not been
 specifically described [11],[13],[12],[14].

 .Spectral Doppler imaging, in contrast to color Doppler imaging, provides inherently
 objective, quantitative data such as peak systolic velocity (PSV) and resistive index (RI)
 values. These measurements have found utility in the assessment of the carotid arteries and,
 for example, both native as well as transplanted hepatic and renal vessels[16],[17]. Early
 investigations addressed the RI in appendicitis as well, without emphasis on the PSV, using
 instrumentation that was modern for the time [18],[19],[20].
Inclusion Criteria:

 -  Patients with acute abdomen and suspected appendicitis.

 Exclusion Criteria:

 -  so Obese and irritable Patients whom satisfactory graded compression US can't be done.

 -  pregnant women , children under 3 years old and adults over 60 years old for radiation
 hazards.

 -  patients with renal impairment for contrast hazards.