Acute appendicitis represents a prevalent condition within the spectrum of acute abdominal pathologies, exhibiting a diverse clinical presentation. Computed tomography (CT) imaging has emerged as a prospective diagnostic modality for the identification and differentiation of appendicitis. This review aims to synthesize current applications, progress, and challenges in integrating machine learning (ML) with CT for diagnosing acute appendicitis while exploring prospects. ML-driven advancements include automated detection, differential diagnosis, and severity stratification. For instance, deep learning models such as AppendiXNet achieved an AUC of 0.81 for appendicitis detection, while 3D convolutional neural networks (CNNs) demonstrated superior performance, with AUCs up to 0.95 and an accuracy of 91.5%. ML algorithms effectively differentiate appendicitis from similar conditions like diverticulitis, achieving AUCs between 0.951 and 0.972. They demonstrate remarkable proficiency in distinguishing between complex and straightforward cases through the innovative use of radiomics and hybrid models, achieving AUCs ranging from 0.80 to 0.96. Even with these advancements, challenges remain, such as the "black-box" nature of artificial intelligence, its integration into clinical workflows, and the significant resources required. Future directions emphasize interpretable models, multimodal data fusion, and cost-effective decision-support systems. By addressing these barriers, ML holds promise for refining diagnostic precision, optimizing treatment pathways, and reducing healthcare costs.
