MDCT appearance of the appendix: how does the low-density barium sulfate oral contrast agent affect it?

We compared the effect of low-density barium sulfate neutral oral contrast agent on the diameter of normal appendix and its luminal content versus that of water on multidetector-row CT. CT scans of 24 patients who had been imaged on two separate occasions for the evaluation of pancreatic pathology, once with water and subsequently with low-density barium sulfate as the neutral oral contrast agent were evaluated (total of 48 scans). Studies were randomized and reviewed in consensus on a workstation in the stack mode by two radiologists blinded to the type of oral contrast. The appendix was measured at baseline and 10 days later to obtain an average diameter. Results of the water and low-density barium sulfate groups were compared using paired t test. Contents of the appendiceal lumen were also noted (gas, fluid, mixed, and collapsed appendix). The average diameter of the appendix for scans obtained with water and low-density barium sulfate was 4.09 ± 0.87 mm (median, 4.22 mm; range, 2.50-5.65 mm) and 4.13 ± 0.93 mm (median, 4 mm, range, 2.2-5.65 mm), respectively. This difference was not statistically significant (P = 0.69). There was no statistically significant difference in the appendiceal content when water or low-density barium sulfate were used as oral contrast (χ (2) = 4.25, P = 0.89). Low-density barium sulfate does not affect appendiceal content or diameter and, therefore, should not adversely affect evaluation of the appendix on multidetector row CT.