BerbeeWalsh Department of Emergency Medicine, University of Wisconsin - Madison, Madison, Wisconsin, 53706, USA.
Department of Radiology, University of Wisconsin - Madison, Madison, Wisconsin, 53706, USA.
Emerg Radiol. 2021 Aug;28(4):789-796. doi: 10.1007/s10140-021-01923-4. Epub 2021 Mar 17.
We sought to determine the diagnostic accuracy of magnetic resonance (MR) imaging compared with computed tomography (CT) and ultrasound (US) when evaluating for five common pelvic pathologies among women presenting to the emergency department (ED) with right lower quadrant abdominal pain.
This prospective, single-center study was conducted at an academic ED as a sub-analysis of a direct comparison of the diagnostic accuracy of CT and MR in the evaluation of appendicitis. Patients were eligible for participation in the parent study if they were at least 12 years old and had a CT performed for evaluation of possible appendicitis. In the current study, only female patients who also underwent pelvic US were included. Three radiologists independently interpreted each MR examination specifically for the presence of pelvic pathology, knowing that patients had initially undergone imaging evaluation for possible appendicitis. The determination of an independent expert panel of two radiologists and one emergency physician based on surgical pathology, comprehensive chart review, clinical information, and follow-up phone calls served as the reference standard. Test characteristics of MR, CT, and US were calculated based on this; the main outcome measure was the summary sensitivity and specificity of MR versus CT and US.
Forty-one participants were included with a mean age of 27.6 ± 10.8 years. The MR consensus interpretation had an overall sensitivity and specificity of 57.1% (CI 38.8-75.5%) and 97.2% (CI 94.7-99.6%) respectively, for detecting any of the five pelvic pathologies. By comparison, CT exhibited sensitivity and specificity of 66.7% (CI 50.0-83.5%) and 98.3% (CI 96.4-100.0%) while it was 64.3% (CI 46.5-82.0%) and 97.7% (CI 95.6-99.9%) for US, respectively. No significant differences were identified when comparing these modalities. Overall, Fleiss' kappa interrater reliability value for MR interpretation was 0.75, corresponding to substantial agreement between the three readers.
In women who might otherwise undergo multiple imaging tests to evaluate gastrointestinal versus pelvic pathologies, our data suggest that MR may be an acceptable first-line imaging test.
我们旨在确定磁共振（MR）成像与计算机断层扫描（CT）和超声（US）相比，在评估急诊科（ED）以右下腹痛就诊的女性五种常见盆腔病变时的诊断准确性。
这是一项前瞻性、单中心研究，在学术性 ED 进行，是对 CT 和 MR 评估阑尾炎诊断准确性的直接比较的子分析。如果患者年龄至少 12 岁且接受 CT 检查以评估可能的阑尾炎，则符合参加母体研究的条件。在当前研究中，仅纳入了还接受盆腔 US 检查的女性患者。三位放射科医生独立解读每位患者的 MR 检查，专门用于评估盆腔病变，同时了解患者最初接受了可能为阑尾炎的影像学检查。两位放射科医生和一位急诊医生组成的独立专家小组根据手术病理、全面病历回顾、临床信息和随访电话做出诊断，作为参考标准。根据该标准计算 MR、CT 和 US 的测试特征；主要观察指标是 MR 与 CT 和 US 的汇总敏感性和特异性。
41 名参与者入选，平均年龄为 27.6 ± 10.8 岁。MR 共识解读的总体敏感性和特异性分别为 57.1%（95%CI：38.8-75.5%）和 97.2%（95%CI：94.7-99.6%），用于检测五种盆腔病变中的任何一种。相比之下，CT 的敏感性和特异性分别为 66.7%（95%CI：50.0-83.5%）和 98.3%（95%CI：96.4-100.0%），而 US 分别为 64.3%（95%CI：46.5-82.0%）和 97.7%（95%CI：95.6-99.9%）。比较这些模态时未发现显著差异。总体而言，MR 解读的 Fleiss'kappa 组内相关系数值为 0.75，表明三位读者之间具有较高的一致性。
对于那些可能需要进行多次影像学检查以评估胃肠道与盆腔病变的女性患者，我们的数据表明，MR 可能是一种可接受的一线影像学检查方法。
