Skip to main content

Advertisement

SpringerLink
Log in

Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female

  • Original Article
  • Published:
Emergency Radiology Aims and scope Submit manuscript

Abstract

The purpose of this study is to evaluate the performance of a sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy. This IRB-approved, HIPAA compliant study included 127 consecutive pregnant patients imaged for suspected appendicitis between October 2007 and May 2012; all patients initially underwent ultrasound (US) examination, followed by magnetic resonance imaging (MRI) if results of US were negative or equivocal. Computerized tomography (CT) was reserved for cases with inconclusive US and MRI results. The EMR was reviewed, recording results of imaging examinations and clinical outcomes. The diagnostic performance of this sequential multi-modality imaging algorithm was calculated with pathology correlation. Two (1.9 %) of the 127 US examinations reported suspected appendicitis; 125 (98.4 %) were inconclusive. Of the 125 patients with inconclusive US examinations, 103 underwent MRI, of which eight (6.2 %) demonstrated findings of acute appendicitis. Of the 103 patients that received MRI, nine (8.7 %) underwent CT. One patient had a CT performed directly after an inconclusive US exam. No additional cases of appendicitis were detected with CT. The sensitivity and specificity of US alone was 12.5 and 99.2 %, respectively; MRI was 100 and 93.6 %; the sequential multi-modality modality algorithm including US, CT, and MRI was 100 and 98.3 %. The diagnostic performance of this sequential multi-modality imaging algorithm for diagnosing acute appendicitis in pregnancy is high. Given the low yield of US, MRI should be considered the first-line imaging test. Although CT was employed in a small fraction of inconclusive MRI examinations, it still has a role in the diagnostic work-up of the pregnant patient with suspected appendicitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Long SS, Long C, Lai H, Macura KJ (2011) Imaging strategies for right lower quadrant pain in pregnancy. AJR Am J Roentgenol 196(1):4–12

    Article  PubMed  Google Scholar 

  2. Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM (2006) MR imaging evaluation of acute appendicitis in pregnancy. Radiology 238(3):891–899

    Article  PubMed  Google Scholar 

  3. Andersen B, Nielsen TF (1999) Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 78(9):758–762

    Article  CAS  PubMed  Google Scholar 

  4. Mayer IE, Hussain H (1998) Abdominal pain during pregnancy. Gastroenterol Clin N Am 27(1):1–36

    Article  CAS  Google Scholar 

  5. Basaran A, Basaran M (2009) Diagnosis of acute appendicitis during pregnancy: a systematic review. Obstet Gynecol Surv 64(7):481–488

    Article  PubMed  Google Scholar 

  6. Babaknia A, Parsa H, Woodruff JD (1977) Appendicitis during pregnancy. Obstet Gynecol 50(1):40–44

    CAS  PubMed  Google Scholar 

  7. Rosen MP, Ding A, Blake MA et al (2011) ACR Appropriateness Criteria(R) right lower quadrant pain—suspected appendicitis. J Am Coll Radiol 8(11):749–755

    Article  PubMed  Google Scholar 

  8. Israel GM, Malguria N, McCarthy S, Copel J, Weinreb J (2008) MRI vs. ultrasound for suspected appendicitis during pregnancy. J Magn Reson Imaging 28(2):428–433

    Article  PubMed  Google Scholar 

  9. Lim HK, Bae SH, Seo GS (1992) Diagnosis of acute appendicitis in pregnant women: value of sonography. AJR Am J Roentgenol 159(3):539–542

    Article  CAS  PubMed  Google Scholar 

  10. Kennedy A (2000) Assessment of acute abdominal pain in the pregnant patient. Semin Ultrasound CT MR 21(1):64–77

    Article  CAS  PubMed  Google Scholar 

  11. Forsted DH, Kalbhen CL (2002) CT of pregnant women for urinary tract calculi, pulmonary thromboembolism, and acute appendicitis. AJR Am J Roentgenol 178(5):1285

    Article  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. Shetty MK, Garrett NM, Carpenter WS, Shah YP, Roberts C (2010) Abdominal computed tomography during pregnancy for suspected appendicitis: a 5-year experience at a maternity hospital. Semin Ultrasound CT MR 31(1):8–13

    Article  PubMed  Google Scholar 

  14. Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD (2010) Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med 55(1):51–9

    Article  PubMed  Google Scholar 

  15. Lazarus E, Mayo-Smith WW, Mainiero MB, Spencer PK (2007) CT in the evaluation of nontraumatic abdominal pain in pregnant women. Radiology 244(3):784–790

    Article  PubMed  Google Scholar 

  16. 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(5):1175–1183

    Article  PubMed  Google Scholar 

  17. 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(3):749–757

    Article  PubMed  Google Scholar 

  18. Sharp HT (2002) The acute abdomen during pregnancy. Clin Obstet Gynecol 45(2):405–1

    Article  PubMed  Google Scholar 

  19. Stone K (2002) Acute abdominal emergencies associated with pregnancy. Clin Obstet Gynecol 45(2):553–561

    Article  PubMed  Google Scholar 

  20. Sharp HT (1994) Gastrointestinal surgical conditions during pregnancy. Clin Obstet Gynecol 37(2):306–315

    Article  CAS  PubMed  Google Scholar 

  21. Barloon TJ, Brown BP, Abu-Yousef MM, Warnock N, Berbaum KS (1995) Sonography of acute appendicitis in pregnancy. Abdom Imaging 20(2):149–151

    Article  CAS  PubMed  Google Scholar 

  22. Cobben LP, Groot I, Haans L, Blickman JG, Puylaert J (2004) MRI for clinically suspected appendicitis during pregnancy. AJR Am J Roentgenol 183(3):671–675

    Article  PubMed  Google Scholar 

  23. Oto A (2006) MR imaging evaluation of acute abdominal pain during pregnancy. Magn Reson Imaging Clin N Am 14(4):489–501

    Article  PubMed  Google Scholar 

  24. Ames Castro M, Shipp TD, Castro EE, Ouzounian J, Rao P (2001) The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis. Am J Obstet Gynecol 184(5):954–957

    Article  CAS  PubMed  Google Scholar 

  25. Raman SS, Lu DS, Kadell BM, Vodopich DJ, Sayre J, Cryer H (2002) Accuracy of nonfocused helical CT for the diagnosis of acute appendicitis: a 5-year review. AJR Am J Roentgenol 178(6):1319–1325

    Article  PubMed  Google Scholar 

  26. Pooler BD, Lawrence EM, Pickhardt PJ (2012) Alternative diagnoses to suspected appendicitis at CT. Radiology 265(3):733–742

    Article  PubMed  Google Scholar 

  27. Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 27(6):1705–1722

    Article  PubMed  Google Scholar 

  28. Spalluto LB, Woodfield CA, DeBenedectis CM, Lazarus E (2012) MR imaging evaluation of abdominal pain during pregnancy: appendicitis and other nonobstetric causes. Radiographics 32(2):317–334

    Article  PubMed  Google Scholar 

  29. Masselli G, Brunelli R, Casciani E et al (2011) Acute abdominal and pelvic pain in pregnancy: MR imaging as a valuable adjunct to ultrasound? Abdom Imaging 36(5):596–603

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building, 3rd Floor, Boston, MA, 02118, USA

    Vijay Ramalingam, Christina LeBedis, Jacqueline R. Kelly, Jennifer Uyeda, Jorge A. Soto & Stephan W. Anderson

Authors
  1. Vijay Ramalingam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christina LeBedis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jacqueline R. Kelly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jennifer Uyeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jorge A. Soto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stephan W. Anderson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vijay Ramalingam.

Additional information

This paper was based on original research performed at Boston University Medical Center, Department of Radiology. This data was presented at the 2013 Society of Abdominal Radiology meeting.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ramalingam, V., LeBedis, C., Kelly, J.R. et al. Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female. Emerg Radiol 22, 125–132 (2015). https://doi.org/10.1007/s10140-014-1260-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10140-014-1260-y

Keywords

Search

Navigation