Beaumont Health, Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, USA.
Abdom Radiol (NY). 2016 Dec;41(12):2455-2459. doi: 10.1007/s00261-016-0864-y.
The primary objective of this study was to determine the clinical outcomes in cases of appendix nonvisualization with MRI in pregnant patients with suspected appendicitis and the implications of appendix nonvisualization for excluding appendicitis.
Fifty-eight pregnant patients with suspected appendicitis evaluated with MRI at three centers from a single institution were retrospectively reviewed by three radiologists with varying levels of abdominal imaging experience. All scans were performed on a 1.5-Tesla Siemens unit. Cases were evaluated for diagnostic quality, visualization of the appendix, presence of appendicitis, and alternate diagnoses. Clinical outcomes were gathered from the electronic medical record.
Of the 58 patients who underwent MRI for suspected appendicitis, 50 cases were considered adequate diagnostic quality by all three radiologists. The rate of appendix visualization among the three radiologists ranged from 60 to 76% (p = 0.44). The appendix was nonvisualized by at least one of the three radiologists in 25 cases (50%). Of these, none had a final diagnosis of appendicitis including one patient who underwent appendectomy. MRI suggested an alternate diagnosis in 6 (24%) patients with appendix nonvisualization. For the three reviewers, the agreement level on whether or not the appendix was visualized on the MRI had a Light's kappa value of 0.526, indicating a "moderate" level of agreement (p value < 0.01).
Despite only moderate level of interobserver agreement for appendix visualization, appendix nonvisualization on MRI in pregnant patients with suspected appendicitis confers a significant reduction in the risk of appendicitis compared to all comers as long as the study is adequate diagnostic quality and there are no secondary signs of appendicitis present.
本研究的主要目的是确定在疑似阑尾炎的孕妇中，MRI 检查未见阑尾的临床结果，以及未见阑尾对排除阑尾炎的意义。
回顾性分析了一家医院的三个中心对 58 例疑似阑尾炎的孕妇进行 MRI 检查的病例，这些孕妇由三位具有不同腹部影像学经验的放射科医生进行评估。所有扫描均在 1.5T 西门子仪器上进行。评估内容包括诊断质量、阑尾显示情况、阑尾炎存在情况和其他诊断。临床结果从电子病历中收集。
在因疑似阑尾炎接受 MRI 检查的 58 例患者中，有 50 例被三位放射科医生均认为诊断质量足够。三位放射科医生的阑尾显示率范围为 60%至 76%（p=0.44）。至少有一位放射科医生在 25 例（50%）患者中未发现阑尾。这些患者中无一例最终诊断为阑尾炎，包括一名接受阑尾切除术的患者。MRI 对 6 例（24%）阑尾未显示的患者提示了其他诊断。对于三位阅片者，MRI 上是否显示阑尾的一致性水平的 Light's kappa 值为 0.526，表明存在“中度”一致性（p 值<0.01）。
尽管对阑尾显示的观察者间一致性仅为中度，但在疑似阑尾炎的孕妇中，只要 MRI 具有足够的诊断质量，且不存在阑尾炎的次要征象，未见阑尾可显著降低阑尾炎的风险。
