MRI vs. ultrasound for suspected appendicitis during pregnancy

PURPOSE: To compare the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ultrasound (US) and MRI in evaluation of pregnant patients with a clinical suspicion of appendicitis. MATERIALS AND METHODS: A total of 33 pregnant patients with suspected appendicitis underwent US and MRI. The original imaging reports generated at the time of presentation were used for data analysis. Pathology reports were used for disease confirmation in patients who underwent appendectomy. When surgery was not performed, a medical record review was performed. The sensitivity, specificity, PPV, and NPV were calculated for US and MRI in the diagnosis of appendicitis. RESULTS: Five of the 33 patients had pathologically-proven appendicitis. Four of the five patients with appendicitis were correctly diagnosed at MRI while one was interpreted as indeterminate (appendix not seen). At US, one was correctly diagnosed, one was incorrectly diagnosed as normal, and three were interpreted as indeterminate (appendix not seen). In 13 patients, a normal appendix was diagnosed at MRI, none of whom had appendicitis. In three patients, a normal appendix was diagnosed at US, one of whom had appendicitis. When the appendix was visualized at MRI, the sensitivity, specificity, PPV, and NPV for the diagnosis of appendicitis was 100% for all parameters. When the appendix was visualized at US, the sensitivity, specificity, PPV, and NPV for the diagnosis of appendicitis was 50%, 100%, 100%, and 66%, respectively. CONCLUSION: Based on a relatively small number of true-positives, our data suggests that MRI is very useful for the diagnosis and exclusion of appendicitis in pregnant women.     

Interstitial pregnancy: role of MRI

We report the MRI features of two cases of interstitial pregnancy. In both cases, MRI was able to localize the ectopic pregnancy by showing a gestational structure surrounded by a thick wall in the upper part of the uterine wall separated from the endometrium by an uninterrupted junctional zone. Because US may confuse angular and interstitial pregnancies and because interstitial pregnancy has a particular evolutive course, MR imaging may play a key role in the diagnosis and management of women with interstitial pregnancy.     

阑尾炎CT评分在部队急性阑尾炎患者中的应用价值

 目的 探讨阑尾炎CT评分(CTAS)在部队急性阑尾炎(AA)患者中的应用价值。方法 通过参考文献和调查研究制定CTAS系统。调取2018-09至2019-08 35例部队AA患者CT检查资料作为AA组;随机抽取同期35例非阑尾炎(NA)部队官兵腹部CT检查资料作为NA组。回顾性分析两组资料并分别记录其CTAS,了解两组间CTAS差异;根据预测AA的受试者操作特性曲线(ROC曲线)和约登指数(YI)确定最佳截断点,了解CTAS诊断AA的效能。结果 AA组评分均值(5.91±1.90),NA组评分均值(1.51±1.27),组间评分差异有统计学意义(P=0.001)。AA组内不同病理分型评分差异有统计学意义(P=0.001),CTAS越高预示着病变越严重。诊断AA最佳截断点CTAS=3.5(即CTAS≥4时可诊断为AA),敏感性为91.40%,特异性为94.30%,准确率为92.86%。结论 CTAS诊断部队AA患者时,分值≥4分的诊断效能高,有较高临床应用价值。     

Unenhanced MR Imaging in adults with clinically suspected acute appendicitis

Purpose

The purpose of the study was to evaluate unenhanced Magnetic Resonance Imaging (MRI) for the diagnosis of appendicitis or another surgery-requiring condition in an adult population scheduled for emergency appendectomy based on a clinical diagnosis of suspected acute appendicitis.

Materials and methods

The prospective study included 48 consecutive patients (29 female, 19 male, 18-70 years old, mean age = 37.1 years). MRI examination was designed to be comfortable and fast; no contrast was administered. The sequences were performed during quiet respiration. The MRI findings were reviewed by two radiologists and one surgeon independent of each other and compared with surgical and pathological records.

Results

According to the surgical and histopathological findings 30 of 48 patients (63%) had acute appendicitis. Of the remaining 18 patients, 4 patients had no reasons for the clinical symptoms and 14 patients had other pathology.For the three reviewers the performance of MRI in the diagnosis of acute appendicitis showed the following sensitivity, specificity and accuracy ranges: 83-93%, 50-83% and 77-83%. Moderate (κ = 0.51) and fair (κ = 0.31) interobserver agreements in the MR diagnosis of acute appendicitis were found between the reviewers. Sensitivity, specificity and accuracy values for overall performance of MRI in detecting pelvic abnormalities were 100%, 75% (3 of 4 healthy patients were identified by MRI) and 98%, respectively.

Conclusion

Unenhanced fast MRI is feasible as an additional fast screening before the appendectomy. It may prevent unnecessary surgeries. The fast MRI examination can be adequately performed on an MRI unit of broad range of field strengths.     

MR imaging evaluation of acute appendicitis in pregnancy

PURPOSE: To retrospectively assess the diagnostic performance of magnetic resonance (MR) imaging in pregnant patients suspected of having acute appendicitis. MATERIALS AND METHODS: The study was approved by the committee on clinical investigations and was HIPAA compliant. The informed consent requirement was waived. MR images were obtained in 51 consecutive pregnant patients (mean age, 28.3 years) who were clinically suspected of having acute appendicitis. In this protocol for pregnant patients, MR imaging is performed when findings at ultrasonography (US) are inconclusive or additional information is needed. Four patients had appendicitis, which was confirmed at surgery in three patients and at follow-up computed tomography in one patient. Initial interpretations were used for patient care and to calculate diagnostic accuracy. The appendix was considered normal at MR imaging if its diameter was less than or equal to 6 mm or if it was filled with air, oral contrast material, or both. An enlarged fluid-filled appendix (>7 mm in diameter) was considered an abnormal finding. An appendix with a diameter of 6-7 mm was considered an inconclusive finding; in those cases, the presence of periappendiceal inflammation was used for the final diagnosis. Three radiologists retrospectively assessed the visualization of the appendix by using a 5-point scale. Statistical analysis was performed by using the median and Fisher exact tests and the Spearman correlation coefficient. RESULTS: MR images were positive for appendicitis in four patients and inconclusive in three. In the three patients with inconclusive results, the appendix was not seen in two patients and was borderline enlarged (7 mm in diameter) in the third. The overall sensitivity, specificity, prevalence-adjusted positive and negative predictive values, and accuracy for MR imaging was 100%, 93.6%, 1.4%, 100%, and 94.0%, respectively. CONCLUSION: MR imaging is an excellent modality for use in excluding acute appendicitis in pregnant women who present with acute abdominal pain and in whom a normal appendix is not visualized at US.     

MR imaging of the normal appendix and acute appendicitis

PURPOSE: To describe the MR appearance of the normal appendix and the MR imaging characteristics of acute appendicitis with correlation to pathological severity. MATERIALS AND METHODS: A total of 20 volunteers participated in this study to demonstrate normal appendices by MR imaging. A total of 37 consecutive patients with clinically diagnosed acute appendicitis were also scanned. T1-weighted (T1WI) spin-echo images, T2-weighted (T2WI) fast spin-echo, and fat-suppressed spectral presaturation inversion recovery T2-weighted (T2SPIR) fast spin-echo images were obtained. The MR criteria for considering acute appendicitis were as follows: 1) thickening of the appendiceal wall with high intensity on T2WI or T2SPIR; 2) dilated lumen filled with high intensity material on T2WI or T2SPIR; and 3) increased intensity of periappendiceal tissue on T2WI or T2SPIR. RESULTS: The visibility of a normal appendix on MR imaging was 90% (18/20). It appeared as a cord-like structure of medium intensity without fluid collection in the lumen. A total of 30 cases with clinically diagnosed acute appendicitis had positive MR findings and all except one were pathologically proven. The one had cecal diverticulitis. These cases demonstrated filled lumen, with a hypointense wall on T1WI and slightly hyperintense on T2WI or T2SPIR. MR findings correlated well with pathological severity, especially a thicker wall, periappendiceal high intensity, and ascites were useful for suspecting severe appendicitis. CONCLUSION: Correct diagnosis of acute appendicitis was obtained with MRI, and correlated well with its pathological severity. MRI is a powerful alternative for diagnosing acute appendicitis especially for the patients in whom the radiation is major concern.     

多层螺旋CT在急性阑尾炎诊断中的应用价值

目的：探讨多层螺旋 CT 在急性阑尾炎诊断中的应用价值。方法选取30例急性阑尾炎患者作为研究组和30例无任何症状的健康成人作为对照组进行多层螺旋 CT 检查。测量阑尾外径,观察阑尾位置,阑尾腔内液体密度、气体密度,阑尾周围脂肪密度改变及腹膜增厚、腹腔积液等并发表现。结果急性阑尾炎平均阑尾外径为(9.78±2.33)mm,健康成年人平均阑尾外径为(5.05±0.53)mm,二者差异有统计学意义(t=24.85,P <0.01)。阑尾周围组织脂肪密度增高、毛糙25例,占83.33%,CT 值约-40~20 HU;阑尾周围有渗出性改变伴腹膜增厚13例,占43.33%;阑尾管壁增厚、水肿29例,占96.67%;阑尾腔内高密度粪石9例,占30.00%;阑尾炎合并肠梗阻1例(占3.33%);阑尾炎患者并发有腹膜增厚,占80.00%;合并有腹腔积液,占23.33%。结论多层螺旋 CT 全腹部平扫可应用于急性阑尾炎的诊断;当阑尾外径 CT 表现为≥6 mm,阑尾腔积液、腔内粪石、周缘脂肪密度增高、腹膜增厚、腹腔积液等征象,可提示阑尾炎诊断。     

超声检查在急性阑尾炎诊断中的应用价值

目的:探讨超声诊断学在急性阑尾炎诊断中的临床应用价值。方法:采用彩色多普勒超声对93例急性阑尾炎患者进行超声检查,回顾性分析阑尾炎的声像特征,并与手术病理结果对照。结果:急性阑尾炎超声诊断符合率为89.25%(83/93)。结论:超声检查对急性阑尾炎的诊断具有很高的临床应用价值。     

多排螺旋CT在不典型急性阑尾炎诊断中的应用

目的探讨多排螺旋CT在不典型急性阑尾炎诊断中的意义。方法对56例不典型急性阑尾炎患者CT影像、治疗结果进行回顾性分析。结果 56例中,男20例,女36例,年龄17～88岁,平均(51.5±15.7)岁。发病时间1 h～7 d。螺旋CT均显示阑尾图像。CT影像表现为阑尾水肿增粗、管壁增厚33例,其中23例伴有阑尾周围渗出、积液。9例阑尾周围脓肿,5例阑尾腔内发现肠石。15例发现回盲部肠壁增厚,2例发现升结肠肿物。5例显示正常阑尾影像,其中2例发现右附件肿物,2例小肠节段性肠壁增厚,1例肠系膜淋巴结肿大。CT扫描结合临床诊断急性阑尾炎51例,行手术治疗47例,均经病理组织学检查证实。5例排除阑尾炎。结论多排螺旋CT阑尾影像特征对不典型急性阑尾炎诊断和治疗选择有重要价值。     

超声检查在急性阑尾炎早期诊断中的价值

目的探讨超声检查在急性阑尾炎早期诊断中的价值。方法回顾性分析118例急性阑尾炎患者的临床资料。结果急性阑尾炎118例,超声诊断符合率92.4%;其中急性单纯性阑尾炎28例,诊断符合率85.7%;急性化脓性阑尾炎62例,诊断符合率96.7%;急性坏疽性阑尾炎16例,诊断符合率93.6%。混合包块型阑尾炎12例,诊断符合率83.3%。结论超声检查在急性阑尾炎的早期诊断中有较高的价值,结合病史、查体、动态观察及实验室检查可明显提高诊断率。     

Radiologic evaluation of acute appendicitis in the busy community hospital

Purpose: To evaluate the accuracy of limited computed tomography (CT) in the hands of the average radiologist in a busy community hospital assessing a patient for acute appendicitis. Materials and methods: Ninety-six consecutive patients were examined with CT and the results, independently reported, were correlated with histopathologic findings and clinical follow-up. Results: Forty-three patients had acute appendicitis, 53 patients did not; sensitivity was 89 %, specificity 91 %, accuracy 90 %, positive predictive value 91 %, and negative predictive value 90 %. Nonvisualization of the appendix did not necessarily preclude an accurate assessment for acute appendicitis. Conclusion: Limited CT of the pelvis using rectal contrast only is a useful radiographic test for evaluating acute appendicitis, with practical application for the average radiologist in a busy community hospital.     

腹膜外位急性阑尾炎的超声诊断价值

目的：探讨腹膜外位急性阑尾炎的超声表现及其诊断价值。方法：分析21例腹膜外位急性阑尾炎的超声表现,并与手术对照。结果：本文21例腹膜外位急性闹尾炎超声检出率80．95％,接近临床手术结果。结论：在临床和其它检查不能对腹膜外位阑尾炎进行明确诊断时,超声检查能够提供一个实时方便的鉴别诊断方法。     

螺旋CT对急性阑尾炎的诊断价值

目的：探讨螺旋CT对急性阑尾炎的诊断价值。方法：搜集CT提示或诊断为阑尾炎并经手术病理证实的34例患者，回顾性分析其CT征象。结果：15例CT表现为阑尾增粗，壁增厚；26例表现为右下腹或盆腔炎性改变（如周围脂肪密度增高、肠周积液、蜂窝织炎、脓肿、腔外气体、淋巴结肿大、相邻肠管增厚、阑尾结石或粪石）；6例盲肠末端有局限性增厚；4例右侧腰大肌影模糊。结论：CT诊断急性阑尾炎有独到之处，能为临床合理治疗提供帮助。     

急性阑尾炎超声诊断的图像特征及临床价值

目的探讨超声在诊断急性阑尾炎中的图像特征及诊断价值。方法回顾性分析经临床手术证实的78例急性阑尾炎患者的超声资料。结果病理诊断单纯性阑尾炎23例，化脓性阑尾炎39例，坏疽性阑尾炎10例，阑尾周围脓肿6例。结论急性阑尾炎具有较典型的超声声像图特征，可为临床提供客观的诊断依据。     

腔内凸阵探头在急性阑尾炎诊断中的临床价值

目的:探讨腔内凸阵探头在急性阑尾炎诊断中的临床价值。方法:分别用腹部低频凸阵探头、高频线阵探头、腔内凸阵探头对54例临床可疑急性阑尾炎患者进行检查,首先判断阑尾及其位置,再根据阑尾管径及长径、管壁回声及腔内回声、肠系膜淋巴结有无肿大、阑尾周围有无积液等改变诊断阑尾炎,并将检查结果与手术病理结果对比。结果:经腹部低频凸阵探头诊断急性阑尾炎28例,漏诊20例,诊断符合率为58.3%,排除急性阑尾炎4例;高频线阵探头诊断急性阑尾炎43例,漏诊5例,诊断符合率为89.6%;腔内凸阵探头诊断急性阑尾炎42例,漏诊6例,诊断符合率为87.5%,排除急性阑尾炎3例。结论:腔内凸阵探头既可定位诊断阑尾的位置,了解阑尾与周围脏器的关系及病变情况,减少误诊、漏诊率,也可定性诊断阑尾的严重程度,对诊断急性阑尾炎有较高的临床价值。     

不同频率超声探头在高原地区急性阑尾炎诊断中的应用

目的：探讨低频、高频、阴道探头相结合的方法在高原地区急性阑尾炎诊断中的价值。方法：回顾性分析2010-05-2012-05间临床怀疑阑尾炎的113例患者的超声检查结果,并与手术结果进行对照分析;每位患者术前分别用3种探头经腹检查1次,可经阴道检查的女性再行经阴道检查。结果：113例中,超声提示阑尾炎的98例中手术证实96例,仅高频探头诊断45例（46.9%）,低频探头诊断12例（12.5%）,阴道探头诊断（包括经腹和经阴道扫查）16例（16.7%）,其中经腹诊断11例,经阴道扫查的45例共诊断5例;23例为2种或3种方法同时诊断。误诊2例,1例为小儿肠系膜淋巴结炎,1例为盆腔炎;超声检查呈阴性的15例中,手术证实5例为阑尾炎。本研究的超声诊断敏感性为95.0%,特异性83.3%,准确性93.8%,阳性预测率98.0%,阴性预测率66.7%。结论：阴道探头与低频探头、高频探头相结合的方法对急性阑尾炎具有较高的诊断价值,超声检查已成为高原地区诊断急性阑尾炎不可缺少的影像检查方法。