Integrating MR Imaging into the Clinical Workup of Pregnant Patients Suspected of Having Appendicitis Is Associated with a Lower Negative Laparotomy Rate: Single-Institution Study

Rapp, Elliot J.; Naim, Farah; Kadivar, Khadijeh; Davarpanah, Amir H.; Cornfeld, Daniel

doi:10.1148/radiol.12121027

Cited by 53 publications

(25 citation statements)

References 25 publications

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“…In this meta-analysis, indeterminate results (in which the appendix was not visualized and there was no peri-cecal fat stranding) were interpreted as negative results for the purposes of calculating performance characteristics [4]. In another report, the routine use of MRI in a single institution decreased the NA by 47% without significantly changing the perforation rate [11]. In Washington State, SCOAP data suggest that MRI is being increasingly utilized in the evaluation of pregnant women for possible appendicitis, as nearly one-third of pregnant patients in the database underwent MRI.…”

Section: Discussionmentioning

confidence: 99%

Single institution and statewide performance of ultrasound in diagnosing appendicitis in pregnancy

Drake

Kotagal

Simmons

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective Assess the performance of ultrasound (US) in pregnant patients presenting with acute abdominal pain concerning for appendicitis. Methods Descriptive analysis of pregnant patients who underwent an US for acute abdominal pain over a 6-year period using data from a statewide quality improvement collaborative and a single center. Results Statewide, 131 pregnant patients underwent an appendectomy and 85% had an US. In our single-center case series, 49 pregnant patients underwent an US for acute abdominal pain and four patients had appendicitis (8%). Of those, three were definitively diagnosed with US. The appendix was visualized by US in five patients (3 appendicitis/2 normal). Mean gestational age was 11 weeks for visualization of the appendix versus 20 weeks for non-visualization (p < 0.001). Concordance between US and pathology was similar statewide and at our institution (43%). Conclusions US appears to play a central role in the evaluation of appendicitis in pregnant women, especially in the first trimester, and often contributes to definitive disposition. US performed less well in excluding appendicitis; however, in certain clinical settings, providers appeared to trust US findings. From these results, we developed a multidisciplinary imaging pathway for pregnant patients who present with acute abdominal pain concerning for appendicitis.

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Section: Discussionmentioning

confidence: 99%

Single institution and statewide performance of ultrasound in diagnosing appendicitis in pregnancy

Drake

Kotagal

Simmons

et al. 2014

The Journal of Maternal-Fetal & Neonatal Medicine

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“…However, MRI provides a valuable tool for evaluation of pregnant patients with right lower abdominal quadrant pain due to features such as lack of ionizing radiation, the excellent safety profile, the exceptional characterization of pathologic tissue, and the capability of direct multiplanar cross-sectional imaging [10,12,14]. Moreover, MRI provides a systemic evaluation of the abdomen and/or pelvis, which enables identifying appendicitis as well as numerous other diagnoses [18]. MRI has a reported sensitivity of 80%e100% [5,15,18] and has the major diagnostic strength of being highly specific (93%e100% [5,15,18]).…”

Section: Tablementioning

confidence: 99%

“…Moreover, MRI provides a systemic evaluation of the abdomen and/or pelvis, which enables identifying appendicitis as well as numerous other diagnoses [18]. MRI has a reported sensitivity of 80%e100% [5,15,18] and has the major diagnostic strength of being highly specific (93%e100% [5,15,18]). In comparison to ultrasonography, MRI visualizes a higher percentage of appendices (52%e66.7% [13,15] versus 3%e12% [13,15]) Rapp et al [18] concluded that the routine incorporation of MRI into the clinical workup for suspicion of appendicitis in pregnant patients was associated with a decrease in the negative appendectomy rate of 47% without a significant change in perforation rate.…”

Section: Tablementioning

confidence: 99%

Impact of appendicitis during pregnancy: No delay in accurate diagnosis and treatment

Aggenbach

Zeeman

Cantineau

et al. 2015

International Journal of Surgery

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Both (perforated) appendicitis and negative appendectomy during pregnancy are associated with a high risk of premature delivery. Clinical presentation and imaging remains vital in deciding whether surgical intervention is indicated. We recommend to cautiously weigh the risks of delay until correct diagnosis with associated increased risk of appendiceal perforation and the risk of unnecessary surgical intervention. Based upon current literature, we recommend clinicians to consider an MRI following an inconclusive or negative abdominal ultrasound aiming to improve diagnostic accuracy to reduce the rate of negative appendectomies. Accurate and prompt diagnosis of acute appendicitis should be strived for to avoid unnecessary exploration and to aim for timely surgical intervention in pregnant women suspected of having appendicitis.

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“…Few studies have demonstrated the effect of MRI on NLR, though its accuracy for diagnosing appendicitis has been shown to be similar to CT (14–16). One center found that the NLR for pregnant women dropped from 55% to 29% when MRI was introduced into the diagnostic pathway (17). …”

Section: Introductionmentioning

confidence: 99%

Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center

Repplinger

Weber

Pickhardt

et al. 2016

Journal of the American College of Radiology

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Objective To quantify the trends in imaging use for the diagnosis of appendicitis. Methods Retrospective study at an academic medical center over a 22-year period. Patients were identified by ICD-9 diagnosis code for appendicitis. Medical record data extraction of these patients included imaging test used (ultrasound, CT, or MRI), gender, age, and body mass index (BMI). The proportion of patients undergoing each scan was calculated by year. Regression analysis was performed to determine whether age, gender, or BMI affected the imaging choice. Results There were 2108 patients in this study, including 967 (43.5%) females and 599 (27%) children (<18 years old). CT use increased over time for the entire cohort (2.9% to 82.4%, p<0.0001) and each subgroup (males, females, adults, pediatrics, p<0.0001 for each). CT use increased more in females and adults than males and pediatric patients, though the differences in trends were not statistically significant (male vs. female p=0.8, adult vs. pediatric p=0.1). The percentage of patients who had no imaging used for the diagnosis of appendicitis decreased over time (p<0.0001 overall and each subgroup), and there was no difference in trends between complementary subgroups (males vs. female p=0.53, adults vs pediatrics p=0.66). There were no statistically significant changes in the use of ultrasound or MRI over the study period. With increasing BMI, CT was more frequently used. Conclusion Of those diagnosed with appendicitis at an academic medical center, CT use increased over 20-fold. However, there was not a statistically significant trend towards increased use of ultrasound or MRI.

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Integrating MR Imaging into the Clinical Workup of Pregnant Patients Suspected of Having Appendicitis Is Associated with a Lower Negative Laparotomy Rate: Single-Institution Study

Abstract: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121027/-/DC1.

Cited by 53 publications

References 25 publications

Single institution and statewide performance of ultrasound in diagnosing appendicitis in pregnancy

Single institution and statewide performance of ultrasound in diagnosing appendicitis in pregnancy

Impact of appendicitis during pregnancy: No delay in accurate diagnosis and treatment

Trends in the Use of Medical Imaging to Diagnose Appendicitis at an Academic Medical Center

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