Kahana Noam, Boaz Elad, Neymark Mariya, Gilshtein Hayim, Dror Yossi Freier, Benjaminov Ofer, Reissman Petachia, Tankel James
Department of General Surgery, Shaare Zedek medical center, the Hebrew University School of Medicine, Jerusalem, Israel.
Department of General Surgery, Rambam Health Care Center, Haifa, Israel.
Eur J Trauma Emerg Surg. 2024 Dec;50(6):3273-3279. doi: 10.1007/s00068-024-02538-3. Epub 2024 May 16.
Advanced imaging may augment the diagnostic milieux for presumed acute appendicitis (AA) during pregnancy, however it is not clear when such imaging modalities are indicated. The aim of this study was to assess the sensitivity and specificity of clinical scoring systems with the findings on magnetic resonance imaging (MRI) of AA in pregnant patients.
A retrospective cohort study between 2019 and 2021 was performed in two tertiary level centers. Pregnant patients presenting with suspected AA and non-diagnostic trans-abdominal ultrasound who underwent MRI as part of their evaluation were identified. Patient demographics, parity, gestation, presenting signs, and symptoms were documented. The Alvarado and Appendicitis Inflammatory Response (AIR) score for each patient were calculated and correlated with clinical and MRI findings. Univariate analysis was used to identify factors associated with AA on MRI.
Of the 255 pregnant patients who underwent MRI, 33 (13%) had findings of AA. On univariate analysis, presentation during the second/third trimester, migration of pain, vomiting and RLQ tenderness correlated with MRI findings of AA. Whilst 5/77 (6.5%) of patients with an Alvarado score ≤4 had signs of AA on MRI, a score of ≥5 had a sensitivity, specificity, negative and positive predictive value of 84.8%, 36.6%, 94.0% and 17.2%. For an AIR score ≥ 5, this was 78.8%, 41.5%, 93.0%, and 16.7%, respectively.
Whilst clinical scoring systems may be useful in identifying which pregnant patients require MRI to be performed when AA is suspected, the low sensitivity implies further research is needed to refine the use of this valuable resource.
先进的影像学检查可能会改善孕期疑似急性阑尾炎（AA）的诊断环境，然而目前尚不清楚何时需要进行此类影像学检查。本研究的目的是评估临床评分系统与孕妇AA的磁共振成像（MRI）检查结果之间的敏感性和特异性。
2019年至2021年间在两家三级中心进行了一项回顾性队列研究。纳入了因疑似AA就诊且经腹超声检查未明确诊断而接受MRI检查的孕妇。记录患者的人口统计学资料、产次、孕周、临床表现和症状。计算每位患者的阿尔瓦拉多（Alvarado）评分和阑尾炎炎症反应（AIR）评分，并与临床和MRI检查结果进行关联分析。采用单因素分析确定与MRI诊断AA相关的因素。
在接受MRI检查的255名孕妇中，33名（13%）有AA的检查结果。单因素分析显示，孕中晚期出现症状、疼痛转移、呕吐和右下腹压痛与MRI诊断的AA相关。阿尔瓦拉多评分≤4的患者中，5/77（6.5%）在MRI上有AA的表现，而评分≥5时，其敏感性、特异性、阴性预测值和阳性预测值分别为84.8%、36.6%、94.0%和17.2%。对于AIR评分≥5的情况，上述指标分别为78.8%、41.5%、93.0%和16.7%。
虽然临床评分系统可能有助于确定哪些疑似AA的孕妇需要进行MRI检查，但敏感性较低表明需要进一步研究以优化这一宝贵资源的使用。
