Using MRI appendicitis scale and DWI for the diagnosis of acute appendicitis in pregnant women.
Appendicitis
Diffusion-weighted imaging
Magnetic resonance imaging
Pregnant women
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
02 Sep 2023
02 Sep 2023
Historique:
received:
16
09
2022
accepted:
09
08
2023
revised:
05
08
2023
medline:
2
9
2023
pubmed:
2
9
2023
entrez:
1
9
2023
Statut:
aheadofprint
Résumé
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). 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. 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. 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. 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. • 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.
Identifiants
pubmed: 37658138
doi: 10.1007/s00330-023-10162-9
pii: 10.1007/s00330-023-10162-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s), under exclusive licence to European Society of Radiology.
Références
Kave M, Parooie F, Salarzaei M (2019) Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women. World J Emerg Surg 14:37
doi: 10.1186/s13017-019-0254-1
pubmed: 31367227
pmcid: 6647167
Franca Neto AH, Amorim MM (1992) Nobrega BM (2015) Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras 61:170–177
doi: 10.1590/1806-9282.61.02.170
Nakashima M, Takeuchi M, Kawakami K (2021) Clinical outcomes of acute appendicitis during pregnancy: conservative management and appendectomy. World J Surg 45:1717–1724
doi: 10.1007/s00268-021-06010-w
pubmed: 33635341
Abbasi N, Patenaude V, Abenhaim HA (2014) Management and outcomes of acute appendicitis in pregnancy-population-based study of over 7000 cases. BJOG 121:1509–1514
doi: 10.1111/1471-0528.12736
pubmed: 24674238
Andersen B, Nielsen TF (1999) Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 78:758–762
pubmed: 10535336
Brown JJ, Wilson C, Coleman S, Joypaul BV (2009) Appendicitis in pregnancy: an ongoing diagnostic dilemma. Colorectal Dis 11:116–122
doi: 10.1111/j.1463-1318.2008.01594.x
pubmed: 18513191
Aggenbach L, Zeeman GG, Cantineau AE, Gordijn SJ, Hofker HS (2015) Impact of appendicitis during pregnancy: no delay in accurate diagnosis and treatment. Int J Surg 15:84–89
doi: 10.1016/j.ijsu.2015.01.025
pubmed: 25638737
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 36:596–603
doi: 10.1007/s00261-010-9654-0
pubmed: 21052664
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
doi: 10.1148/radiol.2503081078
pubmed: 19244044
Basaran A, Basaran M (2009) Diagnosis of acute appendicitis during pregnancy: a systematic review. Obstet Gynecol Surv 64:481–488 (quiz 499)
doi: 10.1097/OGX.0b013e3181a714bf
pubmed: 19545456
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
doi: 10.1097/AOG.0b013e318180a505
pubmed: 18669732
Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505
doi: 10.1016/S0140-6736(12)60815-0
pubmed: 22681860
pmcid: 3418594
Yoon I, Slesinger TL (2021) Radiation exposure in PregnancyStatPearls, Treasure Island (FL)
Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK (2007) Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics 27:1705–1722
doi: 10.1148/rg.276075002
pubmed: 18025513
Baruch Y, Canetti M, Blecher Y, Yogev Y, Grisaru D, Michaan N (2019) The diagnostic accuracy of ultrasound in the diagnosis of acute appendicitis in pregnancy. J Matern Fetal Neonatal Med. https://doi.org/10.1080/14767058.2019.1592154:1-6
doi: 10.1080/14767058.2019.1592154:1-6
pubmed: 30843442
Kazemini A, Reza Keramati M, Fazeli MS, Keshvari A, Khaki S, Rahnemai-Azar A (2017) Accuracy of ultrasonography in diagnosing acute appendicitis during pregnancy based on surgical findings. Med J Islam Repub Iran 31:48
doi: 10.14196/mjiri.31.48
pubmed: 29445677
pmcid: 5804447
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):e691-696
Burns M, Hague CJ, Vos P, Tiwari P, Wiseman SM (2017) Utility of magnetic resonance imaging for the diagnosis of appendicitis during pregnancy: a canadian experience. Can Assoc Radiol J 68:392–400
doi: 10.1016/j.carj.2017.02.004
pubmed: 28728903
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
doi: 10.1148/radiol.12121027
pubmed: 23360736
Wi SA, Kim DJ, Cho ES, Kim KA (2018) Diagnostic performance of MRI for pregnant patients with clinically suspected appendicitis. Abdom Radiol (NY) 43:3456–3461
doi: 10.1007/s00261-018-1654-5
pubmed: 29869102
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
doi: 10.1002/jmri.24316
pubmed: 24151201
Inci E, Kilickesmez O, Hocaoglu E, Aydin S, Bayramoglu S, Cimilli T (2011) Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol 21:768–775
doi: 10.1007/s00330-010-1981-6
pubmed: 20924585
Buckley B, Delaney F, Welaratne I, Windrim C, Geoghegan T, Cronin C (2022) MRI remains highly accurate in the diagnosis of appendicitis in pregnancy when read by radiologists of mixed specialty training and experience. Emerg Radiol. https://doi.org/10.1007/s10140-022-02102-9
doi: 10.1007/s10140-022-02102-9
pubmed: 36422751
Inoue A, Furukawa A, Nitta N et al (2019) Accuracy, criteria, and clinical significance of visual assessment on diffusion-weighted imaging and apparent diffusion coefficient quantification for diagnosing acute appendicitis. Abdom Radiol (NY) 44:3235–3245
doi: 10.1007/s00261-019-02180-3
pubmed: 31420704
Basser PJ, Jones DK (2002) Diffusion-tensor MRI: theory, experimental design and data analysis - a technical review. NMR Biomed 15:456–467
doi: 10.1002/nbm.783
pubmed: 12489095
Pitkin RM, Witte DL (1979) Platelet and leukocyte counts in pregnancy. JAMA 242:2696–2698
doi: 10.1001/jama.1979.03300240036023
pubmed: 501868
Puac P, Rodriguez A, Vallejo C, Zamora CA, Castillo M (2017) Safety of contrast material use during pregnancy and lactation. Magn Reson Imaging Clin N Am 25:787–797
doi: 10.1016/j.mric.2017.06.010
pubmed: 28964468
Fraum TJ, Ludwig DR, Bashir MR, Fowler KJ (2017) Gadolinium-based contrast agents: a comprehensive risk assessment. J Magn Reson Imaging 46:338–353
doi: 10.1002/jmri.25625
pubmed: 28083913