Abstract
Purpose
To investigate the optimal magnetic resonance (MR) imaging protocol in pregnant women suspected of having acute appendicitis.
Materials and methods
One hundred and forty-six pregnant women with suspected appendicitis were included. MR images were reviewed by two radiologists in three separate sessions. In session 1, only axial single-shot turbo spin echo (SSH-TSE) T2-weighted images (WI) were included with other routine sequences. In sessions 2 and 3, coronal and sagittal T2WI were sequentially added. The visibility of the appendix and diagnostic confidence of appendicitis were evaluated in each session using a 5-point grading scale. If diseases other than appendicitis were suspected, specific diagnosis with a 5-point confidence scale was recorded. Diagnostic performance for appendicitis and other diseases were evaluated.
Results
Twenty-five patients (17.1%) were diagnosed with appendicitis. Among the patients with normal appendix, 28 were diagnosed with other disease. Diagnostic performance including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve values for diagnosing appendicitis and other diseases showed no significant difference among sets for both reviewers (p>0.05).
Conclusion
Diagnostic performance of MR in pregnant patients with suspected appendicitis can be preserved with omission of sagittal or both coronal and sagittal SSH-T2WI.
Key points
• Diagnostic performance of appendicitis is preserved with omission of sagittal/coronal T2WIs.
• Diagnosis of other disease may be sufficient with axial T2WIs only.
• Careful serial omission of sagittal and coronal T2WIs can be considered.
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Abbreviations
- MR:
-
Magnetic resonance
- CT:
-
Computed tomography
- SSH-TSE:
-
Single-shot turbo spin echo
- GRE:
-
Gradient echo
- WI:
-
Weighted image
- PPV:
-
Positive predictive value
- NPV:
-
Negative predictive value
- AUC:
-
Area under curve
- ROC:
-
Receiver operating characteristic
References
Sharp HT (2002) The acute abdomen during pregnancy. Clin Obstet Gynecol 45:405–413
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
Smith MP, Katz DS, Lalani T et al (2015) ACR Appropriateness Criteria(R) Right Lower Quadrant Pain--Suspected Appendicitis. Ultrasound Q 31:85–91
Konrad J, Grand D, Lourenco A (2015) MRI: first-line imaging modality for pregnant patients with suspected appendicitis. Abdom Imaging 40:3359–3364
Ditkofsky NG, Singh A (2015) Challenges in magnetic resonance imaging for suspected acute appendicitis in pregnant patients. Current problems in diagnostic radiology 44:297–302
Chen MM, Coakley FV, Kaimal A, Laros RK Jr (2008) Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol 112:333–340
Shin I, An C, Lim JS, Kim MJ, Chung YE (2017) T1 bright appendix sign to exclude acute appendicitis in pregnant women. Eur Radiol. https://doi.org/10.1007/s00330-016-4727-2
Baheti AD, Nicola R, Bennett GL et al (2016) Magnetic Resonance Imaging of Abdominal and Pelvic Pain in the Pregnant Patient. Magn Reson Imaging Clin N Am 24:403–417
Ramalingam V, LeBedis C, Kelly JR, Uyeda J, Soto JA, Anderson SW (2015) Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female. Emerg Radiol 22:125–132
Burke LM, Bashir MR, Miller FH et al (2015) Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study. Am J Obstet Gynecol 213:693.e691–693.e696
Kanal E, Barkovich AJ, Bell C et al (2013) ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 37:501–530
Petkovska I, Martin DR, Covington MF et al (2016) Accuracy of Unenhanced MR Imaging in the Detection of Acute Appendicitis: Single-Institution Clinical Performance Review. Radiology 279:451–460
McGory ML, Zingmond DS, Nanayakkara D, Maggard MA, Ko CY (2005) Negative appendectomy rate: influence of CT scans. Am Surg 71:803–808
(1998) Guidelines for limiting exposure to time-varying electric, magnetic, and electromagnetic fields (up to 300 GHz). International Commission on Non-Ionizing Radiation Protection. Health Phys 74:494-522
Kanal E, Shellock FG, Talagala L (1990) Safety considerations in MR imaging. Radiology 176:593–606
Shellock FG, Crues JV (2004) MR procedures: biologic effects, safety, and patient care. Radiology 232:635–652
Pedrosa I, Lafornara M, Pandharipande PV, Goldsmith JD, Rofsky NM (2009) Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology 250:749–757
Aspelund G, Fingeret A, Gross E et al (2014) Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 133:586–593
Nelson DB, Stewart RD, Matulevicius SA et al (2015) The Effects of Maternal Position and Habitus on Maternal Cardiovascular Parameters as Measured by Cardiac Magnetic Resonance. Am J Perinatol 32:1318–1323
Rapp EJ, Naim F, Kadivar K, Davarpanah A, Cornfeld D (2013) Integrating MR imaging into the clinical workup of pregnant patients suspected of having appendicitis is associated with a lower negative laparotomy rate: single-institution study. Radiology 267:137–144
Cobben L, Groot I, Kingma L, Coerkamp E, Puylaert J, Blickman J (2009) A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy. Eur Radiol 19:1175–1183
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
Funding
This study has received funding by supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2014R1A1A2057091).
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The scientific guarantor of this publication is Yong Eun, Chung.
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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
Hye Sun Lee kindly provided statistical advice for this manuscript.
Informed consent
Written informed consent was waived by the Institutional Review Board.
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Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in European Radiology (Manuscript number: EURA-D-16-01206R1). The study population has been expanded, including patient population from May 2008 to Sep 2015. The previous published study investigated the prevalence of a specific imaging finding representing the normal appendix. In contrast, this current study evaluates the overall diagnostic performance of MR imaging in terms of appendicitis and other diseases than appendicitis in varying degree of planar information. Previous study concentrates on a single imaging feature and draws its clinical implication while current study focuses on the diagnostic performance in terms of deducing the acquisition time.
Methodology
• retrospective
• cross sectional study
• performed at one institution
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Shin, I., Chung, Y.E., An, C. et al. Optimisation of the MR protocol in pregnant women with suspected acute appendicitis. Eur Radiol 28, 514–521 (2018). https://doi.org/10.1007/s00330-017-5038-y
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DOI: https://doi.org/10.1007/s00330-017-5038-y