Jones Andrew Owen, Nol James
Medical Imaging Department Blacktown Mount Druitt Hospitals, Blacktown Hospital, 18 Blacktown Road, Blacktown, Sydney, NSW 2148, Australia.
School of Medicine, Western Sydney University, Sydney, NSW 2751, Australia.
J Clin Med. 2024 Nov 28;13(23):7257. doi: 10.3390/jcm13237257.
: This retrospective observational diagnostic accuracy study aims to demonstrate that open-access rapid-sequence non-contrast magnetic resonance imaging (MRI) is accurate for exclusion or confirmation of acute appendicitis (AA). : In 2017, a locally designed 12 min MRI protocol was made available as a new open-access option (no booking needed) for any emergency department (ED) or acute surgical patient with any clinical presentation at the authors' sites. Uninterrupted single-radiologist reporting availability was provided. A 5-year consecutive report list from 1 January 2019 to 31 December 2023 was recorded in an activity log, from which 3478 eligible reports were identified as ED-based referrals assessing for possible AA. There was "appendicitis possibility" in 581/3478 (17%) reports and "no evidence of appendicitis" in 2897/3478 (83%). These were retrospectively compared with the medical record findings of 557/3478 proven cases of AA (16%). Report availability and reliability metrics have been assessed. : Overall, 2583/3478 reports (74%) were finalized within 2 h of MRI study completion, 3254/3478 (94%) within 4 h. The 3478 reports combined had 98% sensitivity, 98% specificity, 98% accuracy, 94% positive predictive value, and 99% negative predictive value for AA (φ = 0.95). The largest 5-year subgroup, females 15-19 years old, 66/440 with proven AA, had 98% report accuracy. Pregnant women, 21/171 with proven AA, had 99% report accuracy. : The described MRI protocol is accurate for appendicitis assessment and is a suitable first-imaging choice for children, young adults, and pregnant women. It does not require intravenous contrast and poses no radiation risk.
这项回顾性观察性诊断准确性研究旨在证明开放获取的快速序列非增强磁共振成像（MRI）对于排除或确诊急性阑尾炎（AA）是准确的。2017年，一种本地设计的12分钟MRI方案作为一种新的开放获取选项（无需预约）提供给作者所在机构的任何急诊科（ED）或有任何临床表现的急性外科患者。提供不间断的单放射科医生报告服务。2019年1月1日至2023年12月31日的5年连续报告清单记录在活动日志中，从中确定3478份符合条件的报告为基于急诊科的转诊病例，用于评估可能的急性阑尾炎。581/3478（17%）的报告中有“阑尾炎可能性”，2897/3478（83%）的报告中“无阑尾炎证据”。这些报告与557/3478例经证实的急性阑尾炎病例（16%）的病历结果进行了回顾性比较。评估了报告的可用性和可靠性指标。总体而言，3478份报告中的2583份（74%）在MRI研究完成后2小时内完成，3254/3478份（94%）在4小时内完成。这3478份报告对急性阑尾炎的综合敏感性为98%，特异性为98%，准确性为98%，阳性预测值为94%，阴性预测值为99%（φ = 0.95）。最大的5年亚组，即15至19岁的女性，66/440例经证实患有急性阑尾炎，报告准确性为98%。孕妇，21/171例经证实患有急性阑尾炎，报告准确性为99%。所描述的MRI方案对于阑尾炎评估是准确的，并且是儿童、年轻人和孕妇合适的首选成像方法。它不需要静脉注射造影剂，也没有辐射风险。
