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Using MRI appendicitis scale and DWI for the diagnosis of acute appendicitis in pregnant women

  • Emergency Radiology
  • Published:
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Abstract

Objectives

To assess the performance of MRI scale for the diagnosis of acute appendicitis in pregnant women and to determine the added diagnostic value of diffusion-weighted imaging (DWI).

Methods

From January 2018 to December 2020, 80 patients were included. All MRI were performed with a 1.5-Tesla scanner with anterior array body coil. This analysis included (1) T2-weighted imaging (T2WI), (2) fat-saturated T2WI, and (3) DWI. Two radiologists blinded to the diagnosis recorded their assessment of four findings: appendiceal diameter, appendiceal wall thickness, luminal mucus, and periappendiceal inflammation. The MRI scale of acute appendicitis which ranged from 0 to 4 was determined from these factors. An additional one point was added to the MRI appendicitis scale in those patients with evidence of appendiceal restricted diffusion on DWI. The diagnostic values and predictive factors were computed.

Results

Multivariate analysis demonstrated that the calculated MRI appendicitis scale was a significant independent predictor of acute appendicitis with a sensitivity of 96.6%, specificity of 90.2%, and PPV of 84.8%. The odds ratio of appendicitis is increased by 22.3 times for every increase in one point on the MRI appendicitis scale. Therefore, the addition of one point for restricted diffusion in the appendix on DWI imaging can add substantial value, both positive and negative predictive value, towards making an accurate diagnosis of acute appendicitis.

Conclusions

MRI appendicitis scale is an objective and significant independent predictive factor for acute appendicitis in pregnant women. Incorporation of diffusion weighted imaging to MRI can improve diagnosis of acute appendicitis.

Clinical relevance statement

MRI appendicitis scale is an objective and significant independent predictor of acute appendicitis in pregnant women. Incorporation of DWI/ADC map to MRI examinations can improve diagnosis of acute appendicitis in pregnant women.

Key Points

• MRI appendicitis scale is an objective and significant independent predictive factor for acute appendicitis in pregnant women.

• The odds ratio of appendicitis can be increased by 22.3 times for every increase of one unit in MRI scale.

• Incorporation of diffusion-weighted imaging to MRI examinations can add value to the scale (4.2 ± 0.7 vs. 0.7 ± 1.1; p < 0.001) among pregnant women with appendicitis versus pregnant women without appendicitis.

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Abbreviations

CRP:

C-reactive protein

FS-T2WI:

Fat-saturated T2WI

IQR:

Interquartile range

SEG:

Neutrophil

SSFSE:

Single-shot fast spin echo

T2WI:

T2-weighted imaging

WBC:

White blood cell count

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

    Yon-Cheong Wong, Li-Jen Wang, Cheng-Hsien Wu, Yi-Chia Chang & Huan-Wu Chen

  2. Division of Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan

    Being-Chuan Lin & Yu-Pao Hsu

Authors
  1. Yon-Cheong Wong
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  2. Li-Jen Wang
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  4. Yi-Chia Chang
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  7. Yu-Pao Hsu
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Corresponding author

Correspondence to Yon-Cheong Wong.

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Guarantor

The scientific guarantor of this publication is Yon-Cheong Wong.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained. Approved by Institutional Review Board, Chang Gung Medical foundation; reference number 202200218B0D001.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported at European Congress of Radiology in 2020 as an ePoster.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Wong, YC., Wang, LJ., Wu, CH. et al. Using MRI appendicitis scale and DWI for the diagnosis of acute appendicitis in pregnant women. Eur Radiol 34, 1764–1773 (2024). https://doi.org/10.1007/s00330-023-10162-9

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  • DOI: https://doi.org/10.1007/s00330-023-10162-9

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