Pregnant Patients Suspected of Having Acute Appendicitis: Effect of MR Imaging on Negative Laparotomy Rate and Appendiceal Perforation Rate
ABSTRACT To investigate the effect of magnetic resonance (MR) imaging on the negative laparotomy rate (NLR) and the perforation rate (PR) in pregnant patients suspected of having acute appendicitis (AA) and to assess the need for computed tomography (CT) in this setting.
The data of 148 consecutive pregnant patients (mean age, 29 years; age range, 15-42 years; mean gestational age, 20 weeks; gestational age range, 4-37 weeks) who were clinically suspected of having AA and examined with MR imaging between March 2002 and August 2007 were retrospectively analyzed in an institutional review board-approved HIPAA-compliant protocol. One hundred forty patients underwent ultrasonography (US) before MR imaging. The clinical and laboratory data and the findings of the initial US and MR image interpretations were recorded and analyzed at Student t and Fisher exact testing. The NLR and PR were calculated.
Fourteen (10%) patients had AA, and perforation occurred in three (21%) of them. US results were positive for AA in five (36%) patients with proved AA. MR results were positive in all 14 patients with AA. MR results were negative in 125 of the 134 patients without AA; there were nine false-positive cases (two positive, seven inconclusive). Among the patients without AA, the normal appendix could be visualized on US images in less than 2% (two of 126) of cases and on MR images in 87% (116 of 134) of cases (P < .0001). Twenty-seven (18%) patients underwent surgical exploration, and eight of them had negative laparotomy results, yielding an NLR of 30% and a PR of 21% (three of 14 patients). Only four (3%) patients underwent CT.
For pregnant patients clinically suspected of having AA, use of MR imaging yields favorable combinations of NLR and PR compared with previously reported values. The radiation exposure associated with CT examination can be avoided in most cases.
[Show abstract] [Hide abstract]
ABSTRACT: Acute appendicitis during pregnancy may be associated with serious maternal and/or fetal complications. To date, the optimal clinical approach to the management of pregnant women suspected of having acute appendicitis is subject to debate. The purpose of this retrospective study was to provide recommendations for prospective clinical management of pregnant patients with suspected appendicitis.
[Show abstract] [Hide abstract]
ABSTRACT: The assessment of a gravid patient with abdominal pain is a clinical challenge, as one must consider not only the common etiologies for abdominal pain but also etiologies resulting from the pregnancy. Further complicating the assessment is the altered anatomy and physiology that result from the enlarged uterus displacing and compressing normal anatomical structures. This alteration of anatomy makes the symptoms of appendicitis more variable and thus the diagnosis more difficult. Appropriate and timely imaging can result in better patient outcomes, and when appendicitis is suspected, imaging investigation should not be delayed. This article reviews some of the challenges of magnetic resonance imaging in gravid patients with suspected appendicitis and presents strategies for imaging this population. Copyright © 2015 Mosby, Inc. All rights reserved.Current Problems in Diagnostic Radiology 01/2015; DOI:10.1067/j.cpradiol.2015.01.001
Topics in Magnetic Resonance Imaging 01/2014; 23(4):225-242. DOI:10.1097/RMR.0000000000000029