Abstract
Purpose
To evaluate the accuracy of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis in pregnant patients and the value of additional diffusion-weighted MRI (DWI).
Methods
A total of 125 pregnant patients with clinically suspected appendicitis who underwent 1.5 T MRI were enrolled between May 2011 and January 2016. During this period, two radiologists prospectively predicted acute appendicitis on MRI during daily interpretation. We retrospectively reviewed clinical records, and radiological results were correlated with surgical pathology and clinical outcomes. We calculated the sensitivity, specificity, and accuracy of MRI for diagnosing acute appendicitis. We performed additional DWI between August 2014 and January 2016, and we calculated sensitivity, specificity, and accuracy of MRI with or without DWI.
Results
The sensitivity, specificity, and accuracy of MRI for acute appendicitis were 100%, 95%, and 96%, respectively. The sensitivity, specificity, and accuracy of MRI without DWI (n = 72) vs. with DWI (n = 53) were 100%, 94.7%, and 95.8% versus 100%, 95%, and 96%, respectively.
Conclusions
MRI has high accuracy for the diagnosis of acute appendicitis in pregnant patients. Therefore, MRI is recommended for use as a first-line diagnostic test for pregnant patients with clinically suspected appendicitis.
Similar content being viewed by others
References
Yilmaz HG, Akgun Y, Bac B, Celik Y (2007) Acute appendicitis in pregnancy—risk factors associated with principal outcomes: a case control study. Int J Surg 5:192–197
Ueberrueck T, Koch A, Meyer L, Hinkel M, Gastinger I (2004) Ninety-four appendectomies for suspected acute appendicitis during pregnancy. World J Surg 28:508–511
van Randen A, Bipat S, Zwinderman AH, et al. (2008) Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 249:97–106
Pickhardt PJ, Lawrence EM, Pooler BD, Bruce RJ (2011) Diagnostic performance of multidetector computed tomography for suspected acute appendicitis. Ann Intern Med 154:789–796 (w-291)
Wallace CA, Petrov MS, Soybel DI, et al. (2008) Influence of imaging on the negative appendectomy rate in pregnancy. J Gastrointest Surg 12:46–50
Lazarus E, Mayo-Smith WW, Mainiero MB, Spencer PK (2007) CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology 244:784–790
Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E (2012) MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics 32:317–334
Duke E, Kalb B, Arif-Tiwari H, et al. (2016) A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. AJR Am J Roentgenol 206:508–517
Inci E, Kilickesmez O, Hocaoglu E, et al. (2011) Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol 21:768–775
Bayraktutan U, Oral A, Kantarci M, et al. (2014) Diagnostic performance of diffusion-weighted MR imaging in detecting acute appendicitis in children: comparison with conventional MRI and surgical findings. J Magn Reson Imaging 39:1518–1524
Leeuwenburgh MM, Jensch S, Gratama JW, et al. (2014) MRI features associated with acute appendicitis. Eur Radiol 24:214–222
Maslovitz S, Gutman G, Lessing JB, Kupferminc MJ, Gamzu R (2003) The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Invest 56:188–191
Andersen B, Nielsen TF (1999) Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 78:758–762
Singh A, Danrad R, Hahn PF, et al. (2007) MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics 27:1419–1431
Long SS, Long C, Lai H, Macura KJ (2011) Imaging strategies for right lower quadrant pain in pregnancy. AJR Am J Roentgenol 196:4–12
Lehnert BE, Gross JA, Linnau KF, Moshiri M (2012) Utility of ultrasound for evaluating the appendix during the second and third trimester of pregnancy. Emerg Radiol 19:293–299
Bammer R (2003) Basic principles of diffusion-weighted imaging. Eur J Radiol 45:169–184
Le Bihan D (1990) Diffusion/perfusion MR imaging of the brain: from structure to function. Radiology 177:328–329
Leeuwenburgh MM, Wiarda BM, Bipat S, et al. (2012) Acute appendicitis on abdominal MR images: training readers to improve diagnostic accuracy. Radiology 264:455–463
Kanal E, Barkovich AJ, Bell C, et al. (2007) ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 188:1447–1474
Gowland PA, De Wilde J (2008) Temperature increase in the fetus due to radio frequency exposure during magnetic resonance scanning. Phys Med Biol 53:L15–L18
Hand JW, Li Y, Thomas EL, Rutherford MA, Hajnal JV (2006) Prediction of specific absorption rate in mother and fetus associated with MRI examinations during pregnancy. Magn Reson Med 55:883–893
Checkoff JL, Wechsler RJ, Nazarian LN (2002) Chronic inflammatory appendiceal conditions that mimic acute appendicitis on helical CT. AJR Am J Roentgenol 179:731–734
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare no conflicts of interest or sources of funding.
Ethical approval
All procedures performed in this study were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and were in accord with the Helsinki Declaration of 1964 and later versions.
Informed consent
This study was described after approval by the institutional review board, and the requirement for informed consent from individual patients was waived.
Rights and permissions
About this article
Cite this article
Wi, S.A., Kim, D.J., Cho, ES. et al. Diagnostic performance of MRI for pregnant patients with clinically suspected appendicitis. Abdom Radiol 43, 3456–3461 (2018). https://doi.org/10.1007/s00261-018-1654-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-018-1654-5