Byott Sam, Harris Ian
Diagnostic Imaging, Royal Preston Hospital, Sharoe Green Lane, Preston, Lancashire PR2 9HT, UK.
Eur J Radiol. 2016 Jan;85(1):286-290. doi: 10.1016/j.ejrad.2015.10.002. Epub 2015 Oct 9.
To assess T2 HASTE MR in acute abdominal imaging and ascertain if it is a reliable alternative to CT in patients under 60.
In a prospective diagnostic performance study from January 2009 to December 2013, patients under 60 presenting with acute abdominal pain, that required imaging following surgical review, were imaged with T2 HASTE MR. Rapid acquisition HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo) coronal and axial sequences were obtained, without intravenous contrast. Patients were followed up clinically for a minimum of 3 months.
468 cases included in the study. 349 were negative for acute abdominal pathology, 116 positive for acute abdominal pathology and 3 were indeterminate. In the MR positive group (n=116), 64 had surgery confirming findings (34 appendicitis, 14 SBO, 3 ovarian torsion, 3 LBO, intussusception, ovarian carcinoma, ovarian dermoid, 2 pelvic inflammatory disease, diverticular abscess, crohns, 4 endoscopy for acute bowel pathology) while 51 were managed conservatively with concordant follow up (4 SBO, 11 diverticulitis, 6 pelvic inflammatory disease, 7 inflammatory bowel disease, 7 colitis, 6 pyelonephritis, 2 cholecystitis, renal abscess, pseudomembranous colitis, splenic haematoma, mesenteric adenitis, 2 pancreatitis, lymphoma, epiploic appendagitis). 1 patient had an MR diagnosis of appendicitis but at laparoscopy a sigmoid diverticular perforation was diagnosed and the appendix was normal. In the MR negative group (n=349), 324 had uneventful follow-up, 22 had negative laparoscopies, while 3 had subsequent appendectomies, with appendicitis on histology (3 days, 10 days and 2 months post scan). In the MR indeterminate group (n=3), one was treated conservatively with uneventful follow up, one had laparoscopic appendectomy with normal appendix on histology, one had laparoscopic appendectomy with acute appendicitis on histology. When MR correlated with clinical follow up (n=468), overall diagnostic accuracy is 99% (463/468). When MR findings correlated with direct visualisation at surgery/endoscopy (n=90), sensitivity is 98% (95% CI) and specificity is 92% (95% CI).
This study demonstrates that rapid acquisition axial and coronal T2 HASTE MR is a practical, safe and effective method in the diagnosis of acute abdominal pain. MR is the preferred option to CT in patients of an age prone to radiation with a potential surgical diagnosis.
CLINICAL RELEVANCE/APPLICATION: MRI in acute abdominal imaging is both effective and practical and is the preferred imaging option in patients of an age prone to radiation with a potential surgical diagnosis.
评估T2加权快速采集稳态进动序列（T2 HASTE MR）在急性腹部成像中的应用，并确定其在60岁以下患者中是否可作为CT的可靠替代方法。
在2009年1月至2013年12月的一项前瞻性诊断性能研究中，对60岁以下出现急性腹痛且经手术评估后需要成像的患者进行T2 HASTE MR成像。获取快速采集稳态进动序列（半傅里叶采集单次激发快速自旋回波）的冠状位和轴位图像，无需静脉注射造影剂。对患者进行至少3个月的临床随访。
本研究共纳入468例患者。349例急性腹部病变检查结果为阴性，116例为阳性，另有3例结果不确定。在MR检查结果为阳性的组（n = 116）中，6例接受手术，手术结果证实了MR检查结果（34例阑尾炎、14例小肠梗阻、3例卵巢扭转、3例大肠梗阻、肠套叠、卵巢癌、卵巢皮样囊肿、2例盆腔炎、憩室脓肿、克罗恩病、4例因急性肠道病变接受内镜检查），另有51例经保守治疗并随访结果相符（4例小肠梗阻、11例憩室炎、6例盆腔炎、7例炎症性肠病、7例结肠炎、6例肾盂肾炎、2例胆囊炎、肾脓肿、假膜性结肠炎、脾血肿、肠系膜淋巴结炎、2例胰腺炎、淋巴瘤、网膜附件炎）。1例患者MR诊断为阑尾炎，但腹腔镜检查诊断为乙状结肠憩室穿孔，阑尾正常。在MR检查结果为阴性的组（n = 349）中，324例随访无异常，22例行腹腔镜检查结果为阴性，另有3例随后接受阑尾切除术，组织学检查显示为阑尾炎（扫描后3天、10天和2个月）。在MR检查结果不确定的组（n = 3）中，1例经保守治疗随访无异常，1例行腹腔镜阑尾切除术，组织学检查阑尾正常，1例行腹腔镜阑尾切除术，组织学检查为急性阑尾炎。当MR检查结果与临床随访结果（n = 468）相关时，总体诊断准确率为99%（463/468）。当MR检查结果与手术/内镜直视检查结果（n = 90）相关时，敏感性为98%（95%可信区间），特异性为92%（95%可信区间）。
本研究表明，快速采集轴位和冠状位T2 HASTE MR是诊断急性腹痛的一种实用、安全且有效的方法。对于有潜在手术诊断可能且易受辐射影响的年龄段患者，MR是优于CT的选择。
临床意义/应用：MRI在急性腹部成像中既有效又实用，对于有潜在手术诊断可能且易受辐射影响的年龄段患者，是首选的成像检查方法。
