Skip to main content
SpringerLink
Log in

Optimisation of the MR protocol in pregnant women with suspected acute appendicitis

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Purpose

To investigate the optimal magnetic resonance (MR) imaging protocol in pregnant women suspected of having acute appendicitis.

Materials and methods

One hundred and forty-six pregnant women with suspected appendicitis were included. MR images were reviewed by two radiologists in three separate sessions. In session 1, only axial single-shot turbo spin echo (SSH-TSE) T2-weighted images (WI) were included with other routine sequences. In sessions 2 and 3, coronal and sagittal T2WI were sequentially added. The visibility of the appendix and diagnostic confidence of appendicitis were evaluated in each session using a 5-point grading scale. If diseases other than appendicitis were suspected, specific diagnosis with a 5-point confidence scale was recorded. Diagnostic performance for appendicitis and other diseases were evaluated.

Results

Twenty-five patients (17.1%) were diagnosed with appendicitis. Among the patients with normal appendix, 28 were diagnosed with other disease. Diagnostic performance including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve values for diagnosing appendicitis and other diseases showed no significant difference among sets for both reviewers (p>0.05).

Conclusion

Diagnostic performance of MR in pregnant patients with suspected appendicitis can be preserved with omission of sagittal or both coronal and sagittal SSH-T2WI.

Key points

• Diagnostic performance of appendicitis is preserved with omission of sagittal/coronal T2WIs.

• Diagnosis of other disease may be sufficient with axial T2WIs only.

• Careful serial omission of sagittal and coronal T2WIs can be considered.

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

Similar content being viewed by others

Abbreviations

MR:

Magnetic resonance

CT:

Computed tomography

SSH-TSE:

Single-shot turbo spin echo

GRE:

Gradient echo

WI:

Weighted image

PPV:

Positive predictive value

NPV:

Negative predictive value

AUC:

Area under curve

ROC:

Receiver operating characteristic

References

  1. Sharp HT (2002) The acute abdomen during pregnancy. Clin Obstet Gynecol 45:405–413

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Smith MP, Katz DS, Lalani T et al (2015) ACR Appropriateness Criteria(R) Right Lower Quadrant Pain--Suspected Appendicitis. Ultrasound Q 31:85–91

    Article  PubMed  Google Scholar 

  4. Konrad J, Grand D, Lourenco A (2015) MRI: first-line imaging modality for pregnant patients with suspected appendicitis. Abdom Imaging 40:3359–3364

    Article  PubMed  Google Scholar 

  5. Ditkofsky NG, Singh A (2015) Challenges in magnetic resonance imaging for suspected acute appendicitis in pregnant patients. Current problems in diagnostic radiology 44:297–302

    Article  PubMed  Google Scholar 

  6. 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 

  7. Shin I, An C, Lim JS, Kim MJ, Chung YE (2017) T1 bright appendix sign to exclude acute appendicitis in pregnant women. Eur Radiol. https://doi.org/10.1007/s00330-016-4727-2

  8. Baheti AD, Nicola R, Bennett GL et al (2016) Magnetic Resonance Imaging of Abdominal and Pelvic Pain in the Pregnant Patient. Magn Reson Imaging Clin N Am 24:403–417

    Article  PubMed  Google Scholar 

  9. Ramalingam V, LeBedis C, Kelly JR, Uyeda J, Soto JA, Anderson SW (2015) Evaluation of a sequential multi-modality imaging algorithm for the diagnosis of acute appendicitis in the pregnant female. Emerg Radiol 22:125–132

    Article  PubMed  Google Scholar 

  10. 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.e691–693.e696

    Article  Google Scholar 

  11. Kanal E, Barkovich AJ, Bell C et al (2013) ACR guidance document on MR safe practices: 2013. J Magn Reson Imaging 37:501–530

    Article  PubMed  Google Scholar 

  12. Petkovska I, Martin DR, Covington MF et al (2016) Accuracy of Unenhanced MR Imaging in the Detection of Acute Appendicitis: Single-Institution Clinical Performance Review. Radiology 279:451–460

    Article  PubMed  Google Scholar 

  13. McGory ML, Zingmond DS, Nanayakkara D, Maggard MA, Ko CY (2005) Negative appendectomy rate: influence of CT scans. Am Surg 71:803–808

    PubMed  Google Scholar 

  14. (1998) Guidelines for limiting exposure to time-varying electric, magnetic, and electromagnetic fields (up to 300 GHz). International Commission on Non-Ionizing Radiation Protection. Health Phys 74:494-522

  15. Kanal E, Shellock FG, Talagala L (1990) Safety considerations in MR imaging. Radiology 176:593–606

    Article  CAS  PubMed  Google Scholar 

  16. Shellock FG, Crues JV (2004) MR procedures: biologic effects, safety, and patient care. Radiology 232:635–652

    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 250:749–757

    Article  PubMed  Google Scholar 

  18. Aspelund G, Fingeret A, Gross E et al (2014) Ultrasonography/MRI versus CT for diagnosing appendicitis. Pediatrics 133:586–593

    Article  PubMed  Google Scholar 

  19. Nelson DB, Stewart RD, Matulevicius SA et al (2015) The Effects of Maternal Position and Habitus on Maternal Cardiovascular Parameters as Measured by Cardiac Magnetic Resonance. Am J Perinatol 32:1318–1323

    Article  PubMed  Google Scholar 

  20. 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

    Article  PubMed  Google Scholar 

  21. 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 19:1175–1183

    Article  PubMed  Google Scholar 

  22. Duke E, Kalb B, Arif-Tiwari H et al (2016) A Systematic Review and Meta-Analysis of Diagnostic Performance of MRI for Evaluation of Acute Appendicitis. AJR Am J Roentgenol 206:508–517

    Article  PubMed  Google Scholar 

Download references

Funding

This study has received funding by supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2014R1A1A2057091).

Author information

Authors and Affiliations

  1. Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Ilah Shin, Yong Eun Chung, Chansik An, Honsoul Kim, Joon Seok Lim & Myeong-Jin Kim

  2. Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea

    Hye Sun Lee

Authors
  1. Ilah Shin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yong Eun Chung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chansik An
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hye Sun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Honsoul Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Joon Seok Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Myeong-Jin Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yong Eun Chung.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Yong Eun, Chung.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

Hye Sun Lee kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in European Radiology (Manuscript number: EURA-D-16-01206R1). The study population has been expanded, including patient population from May 2008 to Sep 2015. The previous published study investigated the prevalence of a specific imaging finding representing the normal appendix. In contrast, this current study evaluates the overall diagnostic performance of MR imaging in terms of appendicitis and other diseases than appendicitis in varying degree of planar information. Previous study concentrates on a single imaging feature and draws its clinical implication while current study focuses on the diagnostic performance in terms of deducing the acquisition time.

Methodology

• retrospective

• cross sectional study

• performed at one institution

Electronic supplementary material

ESM 1

(DOCX 64 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shin, I., Chung, Y.E., An, C. et al. Optimisation of the MR protocol in pregnant women with suspected acute appendicitis. Eur Radiol 28, 514–521 (2018). https://doi.org/10.1007/s00330-017-5038-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-017-5038-y

Keywords

Search

Navigation