Utilizing the MRI findings to diagnose acute appendicitis in pregnant women

Yıl 2023, , 1387 - 1392, 29.10.2023

Zeynep Yıldız , Fuldem Mutlu

https://doi.org/10.32322/jhsm.1362716

Öz

Aims: To assess the performance of magnetic resonance ımaging (MRI ) scale for the diagnosis of acute appendicitis in pregnant women and to determine the added diagnostic value of MRI imaging.
Methods: In this retrospective study, the data of patients who presented to our hospital emergency department between January 2018 and December 2021, had clinical and laboratory findings consistent with acute appendicitis, and were diagnosed with radiological imaging, were extracted from the hospital automation system and used for statistical analysis. Ultrasound (US) was used as the first-line diagnostic method for pregnant patients, and magnetic resonance imaging (MRI) was used as the second-line diagnostic method. The success of US and MRI examinations in diagnosing acute appendicitis was evaluated. In MRI examinations, the mean values of appendix diameter and wall thickness parameters were examined, and the sensitivity, specificity, positive predictive value, and negative predictive value of periappendiceal fat tissue intensity increase, T2A lumen hyperintensity, and periappendiceal fluid parameters were evaluated. Additionally, the frequency of acute appendicitis according to trimesters was examined. SPSS v20.0 (IBM SPSS Statistics for Windows, Version 20.0; Armonk, NY, USA) package program was used for the analysis.
Results: When the medical records of 200 patients diagnosed with appandicitis were retrospectively examined, it was determined that there were 13 pregnant cases diagnosed with MRI during this period. Sensitivity, specificity, positive predictive value, and negative predictive value were evaluated for parameters including intraluminal T2A hyperintensity, wall thickness, periappendiceal fluid accumulation, and periappendiceal fatty tissue intensity increase. İntraluminal T2A hyperintensity and also periappendiceal fatty tissue intensity increase parameter sensitivity was 100%, however the wall thickness parameter had a sensitivity of 60% and the periappendiceal fluid accumulation parameter had a sensitivity of 80%. the periappendiceal fatty tissue intensity increase parameter had a a specificity of 33.3%, which is the lowest ratio among the other parameters. there was also no significant difference in the frequency of acute appendicitis according to trimesters
Conclusion: MRI examination has a high success rate and can be used as the primary diagnostic method for pregnant appandicitis cases. In terms of parameter evaluation, the highest positive predictive value (90.9%) is found by the parameter of intraluminal T2 hyperintensity, and the parameter of periappendiceal fluid collection is found to be in the second place. The success of T2A lumen hyperintensity and periappendiceal fat tissue intensity increase parameters, especially in excluding negative cases, was found to be quite high.

Anahtar Kelimeler

Magnetic resonance imaging, Acute, Appendicitis, Ultrasonography, Pregnant women

Etik Beyan

sisteme yüklenmiştir.

Kaynakça

• Kave M, Parooie F, Salarzaei M. 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. 2019;14:37. doi:10.1186/s13017-019-0254-1
• Franca Neto AH, Amorim MM, Nóbrega BM. Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras (1992). 2015;61(2):170-177. doi:10.1590/1806-9282.61.02.170
• Wong YC, Wang LJ, Wu CH, et al. Using MRI appendicitis scale and DWI for the diagnosis of acute appendicitis in pregnant women. Eur Radiol. 2023. doi:10.1007/s00330-023-10162-9.
• Basaran A, Basaran M. Diagnosis of acute appendicitis during pregnancy: a systematic review. Obstet Gynecol Surv. 2009;64(7):481-499. doi:10.1097/OGX.0b013e3181a714bf
• Chen MM, Coakley FV, Kaimal A, Laros RK Jr. Guidelines for computed tomography and magnetic resonance imaging use during pregnancy and lactation. Obstet Gynecol. 2008;112(2 Pt 1):333-340. doi:10.1097/AOG.0b013e318180a505
• Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505. doi:10.1016/S0140-6736(12)60815-0
• Aggenbach L, Zeeman GG, Cantineau AE, Gordijn SJ, Hofker HS. Impact of appendicitis during pregnancy: no delay in accurate diagnosis and treatment. Int J Surg. 2015;15:84-89. doi:10.1016/j.ijsu.2015.01.025
• Brown JJ, Wilson C, Coleman S, Joypaul BV. Appendicitis in pregnancy: an ongoing diagnostic dilemma. Colorectal Dis. 2009;11(2):116-122. doi:10.1111/j.1463-1318.2008.01594.x
• Patel SJ, Reede DL, Katz DS, Subramaniam R, Amorosa JK. Imaging the pregnant patient for nonobstetric conditions: algorithms and radiation dose considerations. Radiographics. 2007;27(6):1705-1722. doi:10.1148/rg.276075002
• Baruch Y, Canetti M, Blecher Y, Yogev Y, Grisaru D, Michaan N. The diagnostic accuracy of ultrasound in the diagnosis of acute appendicitis in pregnancy. J Matern Fetal Neonatal Med. 2020;33(23):3929-3934. doi:10.1080/14767058.2019.1592154
• Kazemini A, Reza Keramati M, Fazeli MS, Keshvari A, Khaki S, Rahnemai-Azar A. Accuracy of ultrasonography in diagnosing acute appendicitis during pregnancy based on surgical findings. Med J Islam Repub Iran. 2017;31:48. doi:10.14196/mjiri.31.48
• Burke LM, Bashir MR, Miller FH, et al. Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study. Am J Obstet Gynecol. 2015;213(5):693.e1-693.e6936. doi:10.1016/j.ajog.2015.07.026
• Burns M, Hague CJ, Vos P, Tiwari P, Wiseman SM. Utility of magnetic resonance imaging for the diagnosis of appendicitis during pregnancy: a canadian experience. Can Assoc Radiol J. 2017;68(4):392-400. doi:10.1016/j.carj.2017.02.004
• Rapp EJ, Naim F, Kadivar K, Davarpanah A, Cornfeld D. 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. 2013;267(1):137-144. doi:10.1148/radiol.12121027
• Wi SA, Kim DJ, Cho ES, Kim KA. Diagnostic performance of MRI for pregnant patients with clinically suspected appendicitis. Abdom Radiol (NY). 2018;43(12):3456-3461. doi:10.1007/s00261-018-1654-5
• Ahmed B, Williams J, Gourash W, et al. MRI as First line imaging for suspected acute appendicitis during pregnancy: diagnostic accuracy and level of inter-radiologist agreement. Curr Probl Diagn Radiol. 2022;51(4):503-510. doi:10.1067/j.cpradiol.2021.09.001
• Islam GMN, Yadav T, Khera PS, et al. Abbreviated MRI in patients with suspected acute appendicitis in emergency: a prospective study. Abdom Radiol (NY). 2021;46(11):5114-5124. doi:10.1007/s00261-021-03222-5
• Mervak BM, Wilson SB, Handly BD, Altun E, Burke LM. MRI of acute appendicitis. J Magn Reson Imaging. 2019;50(5):1367-1376. doi:10.1002/jmri.26709
• Cho SU, Oh SK. Diagnostic accuracy of magnetic resonance imaging for acute appendicitis during pregnancy: a systematic review. gebelikte akut apandisit için manyetik rezonans görüntülemenin tanısal doğruluğu: sistematik bir inceleme. Ulus Travma Acil Cerrahi Derg. 2021;27(3):271-277. doi:10.14744/tjtes.2020.02416
• Çınar H, Aygün A, Derebey M, et al. Significance of hemogram on diagnosis of acute appendicitis during pregnancy. Ulus Travma Acil Cerrahi Derg. 2018;24(5):423-428. doi:10.5505/tjtes.2018.62753