Comparison of Imaging Strategies with Conditional Contrast-enhanced CT and Unenhanced MR Imaging in Patients Suspected of Having Appendicitis: A Multicenter Diagnostic Performance Study

Leeuwenburgh, Marjolein M. N.; Wiarda, Bart M.; Wiezer, Marinus J.; Vrouenraets, B. C.; Gratama, Jan W.; Spilt, Aart; Richir, Milan C.; Bossuyt, Patrick M.; Stoker, Jaap; Boermeester, Marja A.

doi:10.1148/radiol.13121753

Cited by 74 publications

(69 citation statements)

References 37 publications

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“…In the future, there might be a place for MRI in the assessment of patients with acute abdominal pain. Recent studies have demonstrated that MRI is sufficiently accurate to diagnose appendicitis and diverticulitis [30,31]. The advantage of MRI over computed tomography is that no administration of contrast media is necessary and that there is no ionizing radiation exposure.…”

Section: Resultsmentioning

confidence: 99%

Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

Gans

Pols²,

Stoker³

et al. 2015

Dig Surg

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169

117

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Introduction: Diagnostic practice for acute abdominal pain at the Emergency Department varies widely and is mostly based on doctor's preferences. We aimed at developing an evidence-based guideline for the diagnostic pathway of patients with abdominal pain of non-traumatic origin. Methods: All available international literature on patients with acute abdominal pain was identified and graded according to their methodological quality by members of the multidisciplinary steering group. A guideline was synthetized, providing evidence-based recommendations together with considerations based on expertise of group members, patient preferences, costs, availability of facilities, and organizational aspects. Conclusions and Recommendations: Definition: Uniform terminology is needed in patients with acute abdominal pain to avoid difficulty in interpretation and ease comparison of findings between studies. We propose the use of the following definition for acute abdominal pain: pain of nontraumatic origin with a maximum duration of 5 days. Clinical diagnosis: Clinical evaluation is advised to differentiate between urgent and nonurgent causes. The diagnostic accuracy of clinical assessment is insufficient to identify the correct diagnosis but can discriminate between urgent and nonurgent causes. Patients suspected of nonurgent diagnoses can safely be reevaluated the next day. Based on current literature, no conclusions can be drawn on the differences in accuracy between residents and specialists. No conclusions can be drawn on the influence of a gynecological consultation. In patients suspected of an urgent condition, additional imaging is justified. CRP and WBC count alone are insufficient to discriminate urgent from nonurgent diagnoses. Diagnostic imaging: There is no place for conventional radiography in the work-up of patients with acute abdominal pain due to the lack of added value on top of clinical assessment. Computed tomography leads to the highest sensitivity and specificity in patients with acute abdominal pain. Positive predictive value of ultrasound is comparable with CT and therefore preferred as the first imaging modality due to the downsides of computed tomography; negative or inconclusive ultrasound is followed by CT. Based on current literature, no conclusions can be drawn on the added value of a diagnostic laparoscopy in the work-up of patients with acute abdominal pain. Antibiotic treatment should be started within the first hour after recognition of sepsis. Administration of opioids (analgesics) decreases the intensity of the pain and does not affect the accuracy of physical examination.

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Section: Resultsmentioning

confidence: 99%

Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

Gans

Pols²,

Stoker³

et al. 2015

Dig Surg

Self Cite

169

117

View full text Add to dashboard Cite

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“…It is not necessary to perform further examinations. In a current multicenter study [43], the three examination methods were performed in a total of 230 patients …”

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confidence: 99%

Imaging of Appendicitis in Adults

Karul

Berliner

Keller

et al. 2014

Fortschr Röntgenstr

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Three imaging modalities are available for the diagnosis of acute appendicitis: ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). Transabdominal ultrasound should be the first-line imaging test. Abdominal CT is superior to US and is required immediately in patients with atypical clinical presentation of appendicitis and suspected perforation. However, low-dose unenhanced CT is equal to standard-dose CT with intravenous contrast agents in the detection of five signs of acute appendicitis (thickened appendiceal wall more than 2?mm, cross-sectional diameter greater than 6?mm, periappendicitis, abscess, and appendicolith). MRI is necessary in pregnant women and young adults. This review illustrates the principles of state-of-the-art imaging techniques and their clinical relevance. Key Points: ??US is the basic diagnostic method in case of suspected appendicitis. ??CT is necessary in patients with atypical presentation of appendicitis. ??MRI should be the first-line imaging test in pregnant women. Citation Format: ??Karul M, Berliner C, Keller S et?al. Imaging of Appendicitis in Adults. Fortschr R?ntgenstr 2014; 186: 551???558

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“…14 Recent studies showed that magnetic resonance imaging (MRI) could accurately replace CT in such a conditional imaging protocol, completely avoiding the radiation risks of CT in children, 15,16 pregnant patients, 17 and the general population. 18 The main disadvantage of a conditional strategy is that some patients have to undergo two examinations, resulting in higher imaging costs and longer waiting times.…”

Section: Resultsmentioning

confidence: 99%