The value of diffusion weighted MR imaging and apparent diffusion coefficient quantification in the diagnosis of perforated and non-perforated appendicitis

Abstract

ORIGINAL ARTICLE PURPOSE We aimed to evaluate the effectiveness of diffusion-weighted magnetic resonance imaging (DW-MRI) and apparent diffusion coefficient (ADC) values in the diagnosis of acute appendicitis and differentiation of perforated and nonperforated appendicitis cases, with histopathologic correlation. MATERIALS AND METHODSSixty consecutive patients (34 males, 26 females; mean age, 35.6±15.5 years; range, 17-83 years) with a presumptive diagnosis of acute appendicitis were included in this prospective study. With a 1.5 Tesla MRI unit, DW-MRI examinations were performed with b values of 50, 400, and 800 s/mm 2 . The mean ADC values of case and control groups, as well as in perforated and nonperforated groups were compared. RESULTSOf the 60 cases, 44 had a radiological diagnosis of acute appendicitis, and 16 were regarded as normal. Of the 40 patients who underwent surgical operation, 12 had a histopathological diagnosis of perforated appendicitis, and 28 had nonperforated appendicitis. Mean ADC value in patients with acute appendicitis (1.01±0.26×10 -3 mm 2 /s) was lower than the control group (1.85±0.13×10 -3 mm 2 /s) (P < 0.001). Mean ADC value of the perforated group (0.79±0.19×10 -3 mm 2 /s) was lower than the nonperforated group (1.11±0.22×10 -3 mm 2 /s) (P < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of DW-MRI in the diagnosis of acute appendicitis were 97.5%, 100%, 97.5%, 100%, and 98.1%, respectively. CONCLUSION DW-MRI and ADC quantification are effective in the diagnosis of acute appendicitis, both in perforated and nonperforated cases. Magnetic resonance imaging (MRI) is the radiological imaging technique offering the highest soft tissue contrast resolution. Currently, in addition to conventional MRI, other MRI techniques are commonly and routinely used, including diffusion-weighted MRI (DW-MRI). DW-MRI is a functional imaging technique that relies on the measurement of the accelerated or slowed microscopic diffusion movements of protons of water molecules. The images are obtained in short interval times and without the requirement for any contrast medium (1).Recently, studies have reported the use of DW-MRI to show active inflammatory lesions in the bowel. In these reports, the mean apparent diffusion coefficient (ADC) of the inflamed bowel segments were compared with the ADC of normal segments, and statistically significant difference was demonstrated (1, 2). Only one study has been investigated the use of DW-MRI for the diagnosis of patients with acute appendicitis (3). However, this study did not focus on the differential diagnosis of perforated and nonperforated appendicitis cases.The aim of this study was to evaluate the effectiveness of DW-MRI and quantitative measurement of ADC values in the diagnosis of acute appendicitis, and in the differentiation between perforated and nonperforated appendicitis cases, with histopathologic correlation. Materials and methods Patient selectionThis prospective study was performed betw...

Imaging of Appendicitis in Adults

“…Research is increasingly focused on the use of diffusionweighted sequences [39,40]. Leeuwenburgh et al discovered limited diffusion in the appendiceal wall as a reliable indicator of acute inflammation [39].…”

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