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Accuracy, criteria, and clinical significance of visual assessment on diffusion-weighted imaging and apparent diffusion coefficient quantification for diagnosing acute appendicitis

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Abstract

Purpose

To assess the accuracy, criteria, and clinical significance of diffusion-weighted imaging (DWI) signal intensity and apparent diffusion coefficient (ADC) quantification for diagnosing acute appendicitis.

Methods

Fifty-one patients with right lower abdominal pain [uncomplicated appendicitis (n = 25), complicated appendicitis (n = 10), and non-appendicitis (n = 16)] who underwent MR examination were enrolled in this retrospective study. Two radiologists independently measured appendiceal diameter and wall thickness. They assessed whether a wall defect, an abscess, extraluminal air, or an appendicolith was present on axial T2WI; evaluated intensity on DWI using a 5-point scale; and determined the ADC values of the appendix and peri-appendiceal tissue. Statistical analysis was performed to assess imaging findings for the diagnosis of appendicitis and complicated appendicitis. Cut-off values were determined using receiver operating characteristic analysis.

Results

For diagnosing acute appendicitis, the accuracy improved from 78.4% using only T2WI to 86.3% using combined T2WI and DWI for reader 1 and from 82.4 to 86.3% for reader 2. For the appendix, the cut-off ADC values that diagnosed appendicitis were 1.41 × 10−3 and 1.26 × 10−3 mm2/s with accuracies of 78.4% and 76.5%, respectively. For the peri-appendiceal tissue, these values of 1.03 × 10−3 and 0.91 × 10−3 mm2/s differentiated between uncomplicated and complicated appendicitis with an accuracy of 97.1%.

Conclusions

Combined DWI and T2WI provided high accuracy for diagnosing appendicitis. The inflamed appendix had lower ADC value than the normal appendix. The peri-appendiceal tissue presenting low ADC value was a notable finding of complicated appendicitis.

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Reproduced from Inoue [35]

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Correspondence to Akitoshi Inoue.

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Inoue, A., Furukawa, A., Nitta, N. et al. Accuracy, criteria, and clinical significance of visual assessment on diffusion-weighted imaging and apparent diffusion coefficient quantification for diagnosing acute appendicitis. Abdom Radiol 44, 3235–3245 (2019). https://doi.org/10.1007/s00261-019-02180-3

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