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Purpose: This study was performed to evaluate the contribution of appendiceal computed tomography (CT) in the more accurate diagnosis of acute appendicitis and decrease in the rate of negative appendectomies. Methods: Between May and August 2005, 146 patients with right lower quadrant (RLQ) abdominal pain and tenderness were diagnosed using appendiceal CT. The appendiceal CT scans were performed with contrast media in the abdominal and pelvic areas. 7 mm slice scans were taken both before and after the contrast media injection, with a time delay. The control group was comprised of 99 patients, who were also checked by abdominal CT or ultrasonography, between December 2004 and April 2005, with the data analyzed retrospectively. Results: In the study group, 85 of the 146 cases were diagnosed with acute appendicitis on appendiceal CT, and had undergone an appendectomy, including 42 men (mean age 39.9 yr) and 43 women (mean age 44.6 yr). The sensitivity and specificity of appendiceal CT in acute appendicitis were 95.3 and 98.4%, respectively. There were 4 (4.7%) negative appendectomy cases; 2 in men and 2 in women. The control group conprised of 47 men and 52 women. There were 13 (13.1%) negative appendectomy cases; 4 in men and 9 in women. Conclusion: The routine use of appendiceal CT, in patients with RLQ abdominal pain and tenderness, resulted in a significant decrease in the negative appendectomy rate. (J Korean Surg Soc 2007;72:113-116)