Thanh Thi Nguyen Thien, Mai Duy Le Huyen, Thanh Nguyen Duy, Quang Nguyen Hieu, Hoang Nguyen Nam, Tan Vo Duc, Cong Phan Chien
Department of Diagnostic Imaging, University Medical Center of Ho Chi Minh City, Ho Chi Minh, VNM.
Cureus. 2023 Dec 30;15(12):e51312. doi: 10.7759/cureus.51312. eCollection 2023 Dec.
Acute appendicitis (AA) is one of the most common surgical emergencies, with a lifetime risk estimated at 7-8%. Pregnant women with appendicitis can have a difficult diagnosis because many signs and symptoms could overlap with other causes of acute abdominal pain. Although magnetic resonance imaging (MRI) is not contraindicated at all gestational ages for units with a field strength of three Tesla or less, there is still much discussion regarding the best protocol to follow in order to minimize survey time and maximize diagnostic efficiency. The purpose of this study was to assess how well different MR pulse sequences can diagnose AA.
This retrospective study involved 179 pregnant females. All patients treated and admitted to the University Medical Center, Ho Chi Minh City, Vietnam, between January 2016 and October 2023 had their MR scans and medical data examined. MRI results were assessed and compared with surgical and histopathological findings.
The mean age of the population was 29.7 ± 4.8 years (range, 18-46 years). On T1-weighted (T1W) and T2-weighted (T2W) sequences, the appendix was clearly visualized at rates of 81.8% and 89.9%, respectively. The sensitivity and specificity of the T2W in diagnosing AA were 93.5% and 92.3%, and when combined with T1W and diffusion-weighted (DW) images, the sensitivity and specificity further increased, being 96.8% and 94.9%, respectively. The predictive value of non-AA of the T1 bright appendix sign was 95.6%.
Our study supports the use of MRI as an imaging test to identify appendicitis during pregnancy, as it has been shown to be a useful method for diagnosing the condition in pregnant women. The T2W pulse sequence is a useful tool for diagnosing appendicitis because of its high sensitivity and specificity. When identifying appendicitis from T2W alone proves challenging, T1W with the T1 bright sign and DW to take advantage of the appendix lumen and/or wall's diffusion features can yield additional information and boost diagnostic confidence.
急性阑尾炎（AA）是最常见的外科急症之一，终生患病风险估计为7%-8%。患有阑尾炎的孕妇可能难以诊断，因为许多体征和症状可能与其他急性腹痛原因重叠。尽管对于场强为3特斯拉或更低的设备而言，磁共振成像（MRI）在所有孕周均无禁忌，但关于遵循何种最佳方案以尽量缩短检查时间并提高诊断效率仍存在诸多讨论。本研究的目的是评估不同的磁共振脉冲序列对急性阑尾炎的诊断效果如何。
这项回顾性研究纳入了179名怀孕女性。对2016年1月至2023年10月期间在越南胡志明市大学医学中心接受治疗并入院的所有患者的磁共振扫描和医疗数据进行了检查。对MRI结果进行评估，并与手术和组织病理学结果进行比较。
研究人群的平均年龄为29.7±4.8岁（范围为18-46岁）。在T1加权（T1W）和T2加权（T2W）序列上，阑尾的清晰显示率分别为81.8%和89.9%。T2W序列诊断急性阑尾炎的敏感性和特异性分别为93.5%和92.3%，当与T1W和扩散加权（DW）图像相结合时，敏感性和特异性进一步提高，分别为96.8%和94.9%。T1亮阑尾征对非急性阑尾炎的预测价值为95.6%。
我们的研究支持将MRI用作孕期识别阑尾炎的影像学检查，因为它已被证明是诊断孕妇阑尾炎的一种有用方法。T2W脉冲序列因其高敏感性和特异性，是诊断阑尾炎的有用工具。当仅通过T2W识别阑尾炎具有挑战性时，结合具有T1亮征的T1W和DW以利用阑尾腔和/或壁的扩散特征，可以提供额外信息并增强诊断信心。
