Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging

Rosenbaum, Daniel G.; Askin, Gülce; Beneck, Debra; Kovanlıkaya, Arzu

doi:10.1007/s00247-017-3900-3

Cited by 20 publications

(11 citation statements)

References 39 publications

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“…MRI is advocated by some for its benefits of being extremely accurate and lack of radiation. 9 , 52 – 57 Although an older study found MRI comparable to US in diagnosing perforated appendicitis, 58 newer studies promote its accuracy, 53 – 55 including the ability to differentiate acute from perforated appendicitis. 52 Several of these studies have also shown excellent accuracy without using contrast.…”

Section: Diagnostic Challengesmentioning

confidence: 99%

“…9 , 52 – 57 Although an older study found MRI comparable to US in diagnosing perforated appendicitis, 58 newer studies promote its accuracy, 53 – 55 including the ability to differentiate acute from perforated appendicitis. 52 Several of these studies have also shown excellent accuracy without using contrast. 53 , 55 Critics mention factors such as availability, time, and cost making MRI impractical for widespread application in pediatrics.…”

Section: Diagnostic Challengesmentioning

confidence: 99%

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Perforation risk in pediatric appendicitis: assessment and management

Howell

Dubina

Lee

2018

PHMT

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Perforated appendicitis, as defined by a visible hole in the appendix or an appendicolith free within the abdomen, carries significant morbidity in the pediatric population. Accurate diagnosis is challenging as there is no single symptom or sign that accurately predicts perforated appendicitis. Younger patients and those with increased duration of symptoms are at higher risk of perforated appendicitis. Elevated leukocytosis, bandemia, high C-reactive protein, hyponatremia, ultrasound, and CT are all useful tools in diagnosis. Distinguishing patients with perforation from those without is important given the influence of a perforation diagnosis on the management of the patient. Treatment for perforated appendicitis remains controversial as several options exist, each with its indications and merits, illustrating the complexity of this disease process. Patients may be managed non-operatively with antibiotics, with or without interval appendectomy. Patients may also undergo appendectomy early in the course of their index hospitalization. Factors known to predict failure of non-operative management include appendicolith, leukocytosis greater than 15,000 white blood cells per microliter, increased bands, and CT evidence of disease beyond the right lower quadrant. In this review, the indications and benefits of each treatment strategy will be discussed and an algorithm to guide treatment decisions will be proposed.

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Section: Diagnostic Challengesmentioning

confidence: 99%

Section: Diagnostic Challengesmentioning

confidence: 99%

Perforation risk in pediatric appendicitis: assessment and management

Howell

Dubina

Lee

2018

PHMT

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“…Even if these methods achieved high specificity values between 85 and 99% for detecting perforated appendicitis, they were associated with either radiation exposure or injection of a contrast medium. 17,18 However, ultrasound is considered to be the most appropriate imaging method to diagnose paediatric AA with a specificity greater than 98%. 19 Moreover, ultrasound was recently shown to be a reliable imaging method to differentiate between perforated and non-perforated appendicitis by means of highly specific findings like the loss of the echogenic submucosal layer and complex periappendiceal fluid.…”

Section: Introductionmentioning

confidence: 99%

Sonographic differentiation of complicated from uncomplicated appendicitis

Rawolle

Reismann

Minderjahn

et al. 2019

The British Journal of Radiology

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Objective: This study aims to differentiate acute uncomplicated and complicated appendicitis, by investigating the correlation between sonographic findings and histological results in different types of paediatric appendicitis. Methods: This is a retrospective study of 1017 paediatric patients (age < 18 years) who underwent ultrasound by paediatric radiologists before appendicectomy at our institution between 2006 and 2016. Histologically, uncomplicated appendicitis was primarily associated with transmural infiltration of neutrophil granulocytes, while complicated appendicitis was characterised by transmural myonecrosis. Logistic regression analyses were used to investigate the association between sonographic and histological findings. Results: Out of 566 (56%) male and 451 (44%) female patients with a mean age of 10.7 years, uncomplicated appendicitis was histologically diagnosed in 446 (44%) children and complicated appendicitis was diagnosed in 348 (34%) cases. The following ultrasound findings were significantly associated with complicated appendicitis in multivariate regression: an increased appendiceal diameter (OR = 1.3, p < .001), periappendiceal fat inflammation (OR = 1.5, p = 0.02), the presence of an appendicolith (OR = 1.7, p = 0.01) and a suspected perforation (OR = 6.0, p < .001) by the pediatric radiologist. For complicated appendicitis, an appendiceal diameter of more than 6 mm had the highest sensitivity (98%), while a sonographically suspected perforation showed the highest specificity (94%). Conclusion: Abdominal sonography by paediatric radiologists can differentiate between uncomplicated and complicated appendicitis in paediatric patients by using an increased appendiceal diameter, periappendiceal fat inflammation, the presence of an appendicolith and a suspected perforation as discriminatory markers. Advances in knowledge: This paper demonstrates expanded information on ultrasound, which is not only an essential tool for diagnosing appendicitis, but also a key method for distinguishing between different forms of appendicitis when performed by paediatric radiologists. Compared with previous studies, the crucial distinction features in our analysis are 1) the definition of gangrene and not primarily perforation as an acute complicated appendicitis enabling early decision-making by sonography and 2) a large number of patients in a particularly affected age group.

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“…MRI is a promising modality in the evaluation of suspected acute appendicitis despite the fact that its reliability in differentiating perforated from simple appendicitis has considered in some Imaging in Suspected Appendicitis http://dx.doi.org/10.5772/intechopen.75035 cases unsatisfactory and MRI findings predictive of appendiceal perforation have not been specifically evaluated clearly; some authors recently have established that contrast-enhanced MRI can differentiate perforated from non-perforated appendicitis in pediatric population based on the appendiceal diameter and another MRI finding like appendiceal restricted diffusion, wall defect, appendicolith, periappendiceal free fluid, remote free fluid, restricted diffusion within free fluid, abscess, peritoneal enhancement, ileocecal wall thickening, and ileus. Abscess, wall defect, and restricted diffusion within free fluid had the greatest specificity for perforation but low sensitivity, and a threshold of any four findings mentioned had the best ability to accurately discriminate between perforated and non-perforated cases, with a sensitivity of 82% and specificity of 85% [21].…”

Section: Magnetic Resonance Imagingmentioning

confidence: 97%

Imaging in Suspected Appendicitis

Romero¹,

Negrette²

2018

Current Issues in the Diagnostics and Treatment of Acute Appendicitis

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Appendicitis is the most suspected diagnosis in patients who consult for abdominal pain, and appendicitis is the most common cause which requires urgent abdominal surgery or intervention. Classically, the diagnosis has been made with the patient's medical history, physical examination, and laboratory findings; however, its preoperative diagnosis is increasingly reliant on imaging. The negative appendectomy rates decreased after the introduction of the use of imaging modalities. The diagnosis of appendicitis should be made early to avoid complications such as perforation. The objective of this chapter is to describe briefly the most important findings in each available image modality and the impact they have on the management and list the potential mimics of appendicitis.

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Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging

Cited by 20 publications

References 39 publications

Perforation risk in pediatric appendicitis: assessment and management

Perforation risk in pediatric appendicitis: assessment and management

Sonographic differentiation of complicated from uncomplicated appendicitis

Imaging in Suspected Appendicitis

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