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.
Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
Eur Radiol. 2018 Feb;28(2):514-521. doi: 10.1007/s00330-017-5038-y. Epub 2017 Sep 11.
To investigate the optimal magnetic resonance (MR) imaging protocol in pregnant women suspected of having acute appendicitis.
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.
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).
Diagnostic performance of MR in pregnant patients with suspected appendicitis can be preserved with omission of sagittal or both coronal and sagittal SSH-T2WI.
• 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.
探讨疑似急性阑尾炎孕妇的最佳磁共振（MR）成像方案。
纳入 146 例疑似阑尾炎的孕妇。由 2 名放射科医生在 3 个不同时段对 MR 图像进行回顾性分析。在第 1 时段，仅纳入轴位单次激发快速自旋回波（SSH-TSE）T2 加权成像（WI）和其他常规序列。在第 2 时段和第 3 时段，分别依次加入冠状位和矢状位 T2WI。在每一阶段，使用 5 分制评分系统评估阑尾的显示情况和阑尾炎的诊断信心。如果怀疑存在除阑尾炎以外的其他疾病，则记录 5 分制的明确诊断。评估阑尾炎和其他疾病的诊断性能。
25 例患者（17.1%）被诊断为阑尾炎。在阑尾正常的患者中，28 例被诊断为其他疾病。对于阑尾炎和其他疾病的诊断性能，包括敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和曲线下面积值，两位阅片者在各个序列组间的差异均无统计学意义（p＞0.05）。
对于疑似阑尾炎的孕妇，省略矢状位或冠状位/矢状位 SSH-T2WI 可保留 MR 的诊断性能。
