MR imaging of the normal appendix and acute appendicitis

Nitta, Norihisa; Takahashi, Masashi; Furukawa, Akira; Murata, Kiyoshi; Mori, Mitsunobu; Fukushima, Masanobu

doi:10.1002/jmri.20241

Cited by 85 publications

(35 citation statements)

References 29 publications

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“…Die MRT ermöglicht eine sehr sensitive und überlagerungsfreie Darstellung der Appendix und der perizäkalen Region. Wichtigste Kriterien der akuten Appendizitis in der MRT sind neben der Verdickung der Appendix der Nachweis eines perizäkalen Fettgewebsödems [22]. In einer aktuellen prospektiven Studie an 138 Patienten, bei denen ein MRT bei klinisch vermuteter Appendizitis durchgeführt wurde, lagen die Sensitivität bei 100% und die Spezifität bei 99% [5].…”

Section: Magnetresonanztomographieunclassified

Akute Appendizitis

Binnebösel

Otto

Stumpf

et al. 2009

Chirurg

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Acute appendicitis is one of the most common acute surgical conditions of the abdomen. Nevertheless, the indications for appendectomy are associated with a high preoperative rate of false diagnoses. Although the rate of unnecessary appendectomies is comparatively high (20-30%) it is considered acceptable because the rate of perforated appendices is 7-30%. With good availability and lack of radiation exposure, ultrasound is the slice imaging modality of first choice. The sensitivity of ultrasonic detection of appendicitis lies between 55 and 98% and the specificity between 78 and 100%. Computed tomography (CT) has a significantly higher sensitivity for detecting acute appendicitis compared to ultrasound both in infancy and adulthood but the specificity shows no significant differences. CT is, therefore, the imaging modality of choice in cases of relevant differential diagnosis that cannot be visualized adequately or inconclusively by sonography especially in obese and critically ill patients. Comparison of ultrasound and magnet resonance imaging (MRI) revealed a significant advantage for MRI regarding accuracy, sensitivity and negative predictive value. In contrast, specificity and positive predictive value showed no significant differences. Currently MRI is only an alternative imaging modality to ultrasound in cases of undetermined and inconclusive ultrasonic findings especially in childhood and pregnancy. The value of ultrasound in the diagnosis of acute appendicitis is increasing and, particularly in the hands of experienced investigators, is an important imaging modality which delivers important and decision-making findings. Nevertheless, the final decision for appendectomy depends on the findings of the physical examination.

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Section: Magnetresonanztomographieunclassified

Akute Appendizitis

Binnebösel

Otto

Stumpf

et al. 2009

Chirurg

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“…ͬͬ [2] For an SSFSE sequence, the repetition time for a given slice will be long (TR Ϸ ϱ); however, the repetition time between SPAIR pulses is 1000 msec, making TI selection a nontrivial matter. A pulse diagram for both fat saturation methods is shown in Fig.…”

Section: Spair-ssfse Techniquementioning

confidence: 99%

“…Fat produces high signal intensity on routine SSFSE that may obscure pathological causes of high signal extending from structures surrounded by fat, such as bowel, pancreas, and kidneys. Disease processes include inflammation, infection, and abnormal fluid collections (1)(2)(3)(4)(5)(6). T2W FS images may have particular value in pregnant patients presenting with an acute abdomen (7,8).…”

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confidence: 99%

Evaluation of optimized inversion‐recovery fat‐suppression techniques for T2‐weighted abdominal MR imaging

Lauenstein

Sharma

Hughes

et al. 2008

Magnetic Resonance Imaging

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Purpose: To test the theoretical benefits of a spectral attenuated inversion-recovery (SPAIR) fat-suppression (FS) technique in clinical abdominal MRI by comparison to conventional inversion-recovery (IR) FS combined with T2-weighted (T2W) partial Fourier single shot fast spin echo (SSFSE).Materials and Methods: 1.5T MRI studies of the abdomen were performed in 28 patients with liver lesions (hemangiomas n ϭ 14; metastases n ϭ 14). T2W sequences were acquired using IR and SPAIR SSFSE. Measurements included retroperitoneal and mesenteric fat signal-to-noise (SNR) to evaluate FS; liver lesion contrast-to-noise (CNR) to evaluate bulk water signal recovery effects; and bowel wall delineation to evaluate susceptibility and physiological motion effects.Results: SPAIR-SSFSE images produce significantly improved FS and liver lesion CNR. The mean SNR of the retroperitoneal and mesenteric fat for SPAIR SSFSE was 20.5 Ϯ 10.2 (Ϯ1 SD) and 12.7 Ϯ 6.2, compared to 43.2 Ϯ 24.1 (P ϭ 0.000006) and 29.3 Ϯ 16.8 (P ϭ 0.0000005) for IR-SSFSE. SPAIR-SSFSE images produced higher CNR for both hemangiomas CNR ϭ 164 Ϯ 88 vs. 126 Ϯ 83 (P ϭ 0.00005) and metastases CNR ϭ 75 Ϯ 27 vs. 53 Ϯ 19 (P ϭ 0.007). Bowel wall visualization was significantly improved using SPAIR-SSFSE (P ϭ 0.002). Conclusion:The theoretical benefits of SPAIR over conventional IR FS translate into significant multiple improvements that can be measured on clinical abdominal MRI scans.

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“…Among the diagnostic methods used in order to improve the diagnosis of acute appendicitis and reduce the amount of ''useless'' appendectomies without increasing the risk of inflammation are ultrasonography (US), computerized tomography (CT) [2], magnetic resonance imaging (MRI) [3], and diagnostic laparoscopy. US performed by an expert reaches an elevated diagnostic accuracy, from 70% to 95% [4].…”

Section: Introductionmentioning

confidence: 99%

Integrated clinical-ultrasonographic diagnosis in acute appendicitis

Summa

Perrone

Priora

et al. 2007

Journal of Ultrasound

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KEYWORDSUltrasonography; Acute appendicitis.Abstract Purpose: Acute appendicitis is one of the commonest diseases encountered in the field of emergency surgery. If untreated, it can rapidly develop severe complications such as perforation and peritonitis. Surgeons therefore often choose early surgical treatment also when the diagnosis is only probable, facing the risk of performing an elevated amount of unnecessary appendectomies. The aim of this study is to analyse our experience with integrated clinical-ultrasonographic diagnosis in acute appendicitis. Material and methods: From January 1999 to December 2006, 1447 patients underwent clinical examination, leucocyte count, evaluation of C-reactive protein level, and abdominal ultrasonography using graded compression technique and a high frequency probe. Results: In 368 patients (25%) ultrasonographic diagnosis was acute appendicitis; 8 patients were operated on the basis of clinical evaluation only. Ultrasonography yielded false positive results in 7 cases. In 1079 patients (75%) diagnosis was negative for acute appendicitis; 173 of these patients (12%) received a different diagnosis. The remaining 906 patients underwent clinical follow-up until the symptoms disappeared; there were no complications. In our study, sensitivity of ultrasonography was 98%, specificity 99%, positive predictive value 98%, and negative predictive value 99%. Overall diagnostic accuracy was 99%. Conclusion: Integrated diagnosis of acute appendicitis based on clinical evaluation, laboratory tests and ultrasonography is safe and saves resources by preventing unnecessary operations.Sommario Scopo: L'appendicite acuta è una delle urgenze chirurgiche addominali più comuni. Se non trattata, può rapidamente progredire verso complicanze severe, quali la perforazione e la peritonite. Spesso i chirurghi optano per un intervento chirurgico precoce anche in caso di diagnosi solo probabile, con il rischio di eseguire una quota importante di appendicectomie inutili. Lo scopo dello studio è di analizzare la nostra esperienza con la diagnosi integrata clinico-ultrasonografica dell'appendicite acuta. Materiali e metodi: Durante il periodo gennaio 1999-dicembre 2006 1447 pazienti sono stati sottoposti a valutazione clinica, a conta leucocitaria, dosaggio della proteina C reattiva ed ecografia addominale. È stata utilizzata la tecnica ecografia di compressione graduale, con sonda ad alta frequenza. Risultati: È stata formulata diagnosi ecografica di appendicite acuta in 368 pazienti (25%). Ulteriori 8 pazienti sono stati operati sulla base del solo giudizio clinico. Abbiamo osservato 7 casi di falsi positivi ecografici. In 1079 (75% del totale) pazienti è stato espresso un giudizio diagnostico negativo per appendicite acuta: in 173 di essi (12%) è stata formulata una diagnosi diversa. I restanti 906 pazienti sono stati sottoposti a controllo clinico fino alla risoluzione della sintomatologia, senza alcuna complicanza. I nostri risultati hanno dimostrato una sensibilità dell'ecografia del 98%, una specifici...

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MR imaging of the normal appendix and acute appendicitis

Cited by 85 publications

References 29 publications

Akute Appendizitis

Akute Appendizitis

Evaluation of optimized inversion‐recovery fat‐suppression techniques for T2‐weighted abdominal MR imaging

Integrated clinical-ultrasonographic diagnosis in acute appendicitis

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