Akut appendisitte difüzyon ağırlıklı görüntülemenin tanıdaki etkisi

Abstract

Amaç: Bu çalışma, akut appendisitin kesin tanısında BT’ye alternatif olarak diffüzyon ağırlıklı görüntüleme (DAG) kullanmanın etkisini ortaya koymaktadır. Yöntem: 5 aylık bir dönemde, akut appendisit şüphesiyle başvuran ve ultrasonografik (US) değerlendirme ardından magnetik rezonans görüntüleme (MRG) yapılmak üzere radyoloji bölümüne yönlendirilen 41 hasta çalışmamıza dahil edildi. İki radyolog, diffüzyon ağırlıklı görüntüleri bağımsız olarak değerlendirdiler. Diffüzyon MRG değerlendirmesinde her B değeri için beş aralıklı bir puanlama sistemi kullanıldı. Puanlama 3 veya daha yüksekse, bu durum akut appendisit olarak kabul edildi. İstatistiksel analiz yapıldı ve karşılaştırmada ROC analizi kullanıldı. Bulgular: Çalışmamızda 41 hasta incelendi. 6 hastanın çalışmadan çıkartılmasından sonra, 35 hastanın (13 kadın, 22 erkek; ortalama yaş: 34, yaş aralığı: 16 ila 80) 19'u (%46) ameliyat edildi ve patoloji so-nuçları akut apandisiti doğruladı. Ameliyat edilen tüm hastaların sonuçları ultrasonografi raporlarıyla uyumluydu. Ancak ultrasonografinin 3 yanlış pozitif sonucu mevcuttu. Bu hastalardan ikisi, iki göz-lemci tarafından, biri ise tek gözlemci tarafından DAG ile appendisit olmadığı şeklinde saptanabildi. DAG için sensitivite, spesifite, pozitif prediktif değer, negatif prediktif değer ve doğruluk oranı sırasıyla %52-89, %50-87.5, %59-80, %68-84 ve %65-80 olarak ölçüldü. Sonuç: Çalışmamıza göre, teknolojinin ilerlemesiyle appendisit vakalarında MRG kullanımının artabi-leceğini ve özellikle seçili vakalarda radyasyon dozu endişesi olmaması nedeniyle BT’yi potansiyel olarak geçebileceğine inanmaktayız.

Keywords

• Appendisit
• Akut batın
• Manyetik Rezonans Görüntüleme

Diagnostic impact of diffusion weighted imaging in acute appendicitis

Abstract

Objective: This study reveals the impact of using diffusion-weighted imaging (DWI) to accurately diagnose acute appendicitis as an alternative to CT. Methods: In our study, 41 patients with suspected acute appendicitis, who had undergone magnetic resonance imaging (MRI) following sonographic (US) evaluation, and been referred to the radiology department during a period of 5 months were included. Two radiologists separately evaluated diffusion-weighted images. A five-range scoring system was used in the evaluation of diffusion MRI for each B-value. Any score that is 3 or higher is considered acute appendicitis. Statistical analysis was performed, and ROC curves were used for comparison. Results: In our study, 41 patients were examined. After the exclusion of 6 patients, out of the 35 patients (13 women, 22 men; mean age: 34, age range: 16 to 80) included in the study, 19 (46%) underwent surgery, and pathology results confirmed acute appendicitis. The results of all operated patients were consistent with the ultrasonography reports. However, ultrasonography had three false-positive results. Of these patients, two were identified by two observers and one by a single observer as not having appendicitis via DWI. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate for DWI were measured as 52-89%, 50-87.5%, 59-80%, 68-84%, and 65-80%, respectively. Conclusion: According to our study, with the advancement of technology, we believe that MRI usage in appendicitis will possibly increase, potentially surpassing CT, especially in selected cases due to the absence of radiation dose concerns.

Keywords

• Appendicitis
• Acute abdomen
• Magnetic Resonance Imaging

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