To determine which factor is associated with presence of fat stranding sign for acute appendicitis on computed tomography (CT).This study reviewed the CT imaging of adults with proven acute appendicitis at a single center from January 1, 2015 to December 31, 2019. Logistic regression models were used to investigate the association between clinical characteristics and fat stranding sign. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff value that helped predict the presence of fat stranding on CT.In total, 413 patients were included. Age of ≥40 years (OR: 3.10; 95% CI, 2.02-4.74; P < .0001), body mass index of ≥23 kg/m (OR: 2.86; 1.89-4.34; P < .0001), white blood cell count of ≥10,000/μl (OR: 1.77; 1.05-2.99; P = .0316), and C-reactive protein level of ≥2.4 mg/dl (OR: 3.17; 1.97-5.08; P < .0001) were significant factors predicting fat stranding on CT. The ROC analysis with above 4 factors showed an area under the curve of 0.76 (0.71-0.80).Body habitus, advanced age, and elevated inflammatory marker levels were independent in predicting fat stranding for patients with acute appendicitis.