将 MRI 成像整合到疑似阑尾炎的孕妇临床评估中可降低阴性剖腹探查率：单中心研究。
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.
机构信息
Department of Internal Medicine, Cambridge Hospital, Cambridge, Mass, USA.
出版信息
Radiology. 2013 Apr;267(1):137-44. doi: 10.1148/radiol.12121027. Epub 2013 Jan 29.
PURPOSE
To determine if integrating magnetic resonance (MR) imaging into the workup of right lower quadrant pain in pregnant patients was associated with improved outcomes as measured by the negative laparotomy rate (NLR) and the perforation rate (PR).
MATERIALS AND METHODS
Institutional review board approval was obtained for this retrospective review of medical records. Two hundred sixty-seven pregnant patients who underwent either surgery (n = 82) or an MR imaging examination (n = 217) because of suspicion of appendicitis between January 1, 1996, and August 31, 2011, were identified. Relevant ultrasonographic and MR imaging reports were classified as showing true-positive, false-positive, true-negative, false-negative, or equivocal findings. MR imaging utilization was analyzed to define pre- and post-MR imaging cohorts. NLR and PR were calculated for both cohorts and were compared by using a Fisher exact probability test. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for MR imaging were calculated.
RESULTS
MR imaging was introduced into the clinical workup in 2004. From 1996 to 2003, the NLR for pregnant patients was 55% (17 of 31), and the PR was 21% (three of 14). From 2004 to 2011, the NLR was 29% (15 of 51), and the PR was 26% (nine of 35). The 47% decline in the NLR ([55%-29%]/55%) was statistically significant (P = .02). The change in PR was not significant (P > .99). The sensitivity, specificity, PPV, and NPV of MR imaging in the diagnosis of appendicitis were 89% (17 of 19), 97% (187 of 193), 74% (17 of 23), and 99% (187 of 189), respectively.
CONCLUSION
The routine incorporation of MR imaging into the clinical workup for suspicion of appendicitis in pregnant patients at this institution was associated with a decrease in the NLR of 47% without a significant change in the PR.
SUPPLEMENTAL MATERIAL
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121027/-/DC1.
目的
通过测量阴性剖腹率（NLR）和穿孔率（PR），确定将磁共振（MR）成像纳入孕妇右下象限疼痛检查是否可改善结局。
材料与方法
本回顾性病历研究经机构审查委员会批准。1996 年 1 月 1 日至 2011 年 8 月 31 日期间，因疑似阑尾炎而行手术（n=82）或 MR 成像检查（n=217）的 267 例孕妇入组。对相关超声和 MR 成像报告进行分类，以显示为真阳性、假阳性、真阴性、假阴性或不确定结果。分析 MR 成像的使用情况，以定义 MR 成像检查前和检查后队列。计算两个队列的 NLR 和 PR，并使用 Fisher 确切概率检验进行比较。计算 MR 成像的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
结果
MR 成像于 2004 年引入临床检查。1996 年至 2003 年，孕妇 NLR 为 55%（31 例中的 17 例），PR 为 21%（14 例中的 3 例）。2004 年至 2011 年，NLR 为 29%（51 例中的 15 例），PR 为 26%（35 例中的 9 例）。NLR 下降 47%[（55%-29%）/55%]，差异有统计学意义（P=.02）。PR 变化无统计学意义（P＞.99）。MR 成像对阑尾炎的诊断敏感性、特异性、PPV 和 NPV 分别为 89%（19 例中的 17 例）、97%（193 例中的 187 例）、74%（23 例中的 17 例）和 99%（189 例中的 187 例）。
结论
本机构常规将 MR 成像纳入疑似阑尾炎孕妇的临床检查中，可使 NLR 下降 47%，而 PR 无显著变化。
补充材料
http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121027/-/DC1.
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