Department of Surgery, Division of Minimally Invasive General and Bariatric Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
Advanced Laparoscopic and General Surgery of Nevada, Las Vegas, NV.
Curr Probl Diagn Radiol. 2022 Jul-Aug;51(4):503-510. doi: 10.1067/j.cpradiol.2021.09.001. Epub 2021 Dec 2.
Evaluation of acute appendicitis (AA) in pregnancy is supported with diagnostic imaging. Typically, ultrasound (US) is performed first, and then often followed by magnetic resonance imaging (MRI) due to continued diagnostic uncertainty. The purpose of our study was to evaluate the sensitivity, specificity, and accuracy of US as compared to MRI and to evaluate the inter-radiologist agreement amongst body Radiologists with varying levels of expertise.
We performed a retrospective study of 364 consecutive pregnant patients with clinical suspicion of AA at a single center over a 6-year period. Sensitivity, Specificity, accuracy, positive and negative predictive values were calculated for US and MRI. Inter Radiologist agreement was determined using Cohen's Kappa analysis between original interpreting Radiologist and retrospective review by expert Radiologist.
Thirty-one of 364 patients (8.5%) underwent appendectomy based on preoperative diagnosis, with confirmation of acute appendicitis (AA) by pathology in 19. US was able to visualize the appendix in only 6 (1.65%), 5 of whom had appendicitis. 141 patients underwent MRI, and correctly diagnosed appendicitis in 9. No patient with a negative MRI diagnosis had AA. The sensitivity, and negative predictive value for diagnosing AA with MRI was 100%. The MRI inter-reader agreement for appendix visualization and overall accuracy were 87.9 and 98% with Cohen Kappa of 0.7 and 0.56 respectively.
Our data suggests that MRI should be considered the first line imaging modality in pregnant patients suspected of having AA. Body Radiologists with varied levels of experience in MRI readouts had substantial agreement.
妊娠合并急性阑尾炎（AA）的诊断主要依靠影像学检查。通常先进行超声（US）检查，由于诊断存在不确定性，通常随后进行磁共振成像（MRI）检查。本研究旨在评估 US 与 MRI 的敏感性、特异性和准确性，并评估不同专业水平的全身放射科医生之间的放射科医生间一致性。
我们对 6 年来在一家中心接受连续 364 例疑似 AA 的妊娠患者进行了回顾性研究。计算 US 和 MRI 的敏感性、特异性、准确性、阳性预测值和阴性预测值。通过原始解读放射科医生与专家放射科医生的回顾性评估之间的 Cohen's Kappa 分析来确定放射科医生间的一致性。
364 例患者中，31 例（8.5%）因术前诊断而行阑尾切除术，术后病理证实为急性阑尾炎（AA）。US 仅能显示 6 例（1.65%）阑尾，其中 5 例为阑尾炎。141 例行 MRI 检查，9 例正确诊断为阑尾炎。无阴性 MRI 诊断的患者患有 AA。MRI 诊断 AA 的敏感性和阴性预测值均为 100%。MRI 对阑尾显示和整体准确性的读者间一致性分别为 87.9%和 98%，Cohen Kappa 分别为 0.7 和 0.56。
我们的数据表明，对于怀疑患有 AA 的妊娠患者，应考虑 MRI 作为一线影像学检查方法。在 MRI 读片方面经验水平不同的全身放射科医生之间具有很大的一致性。
