Periappendiceal Fat Stranding as a Specific Tomographic Sign of Inflammatory and Noninflammatory Appendicopathies

Background Appendicopathies are still ongoing diagnostic challenges, with a rate of morphologically normal appendix removals exceeding 20% due to limitations of the diagnostic exams and scores. The objective of this study was to verify the efficacy of periappendiceal fat stranding identified on computed tomography as a complementary exam in differentiating appendicopathies, specifying inflammatory and noninflammatory disorders. Methods A single-center, cross-sectional observational study was conducted on 200 consecutive patients of varying ages and both sexes submitted to appendectomy due to diagnosis of acute appendicitis. Medical records and imaging exams were assessed, including the Alvarado score and the periappendiceal fat stranding ranking level. This study compared inflammatory and noninflammatory appendicopathies. Statistical significance was set at p < 0.05, with prevalence ratios calculated at a 95% CI and ROC curve analyses applied. Results The exams used in the Alvarado score failed in predicting appendiceal inflammation confirmed by the histopathologic exams. High periappendiceal fat stranding (grades 2 and 3) showed a prevalence ratio of 1.57 (95% CI: 1.31–1.87). The ROC curve's area was 0.924, with grade 3 sensitivity at 74.86% and specificity at 100%, indicating strong predictive level. Conclusion Periappendiceal fat stranding identified on computed tomography scans is efficacious in identifying appendicopathies and in the differential diagnosis of inflammatory and noninflammatory disorders.