Accuracy of unenhanced Mr imaging in the Detection of acute appendicitis: Single-institution clinical performance review1

Iva Petkovska, Diego R Martin, Matthew F. Covington, Shannon Urbina, Eugene Duke, Zhongyin J Daye, Lori A. Stolz, Samuel M Keim, James R. Costello, Surya Chundru, Hina Arif-Tiwari, Dorothy - Gilbertson-Dahdal, Lynn Gries, Bobby T Kalb

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine the accuracy of unenhanced magnetic resonance (MR) imaging in the detection of acute appendicitis in patients younger than 50 years who present to the emergency department with right lower quadrant (RLQ) pain. Materials and Methods: The institutional review board approved this retrospective study of 403 patients from August 1, 2012, to July 30, 2014, and waived the informed consent requirement. A cross-department strategy was instituted to use MR imaging as the primary diagnostic modality in patients aged 349 years who presented to the emergency department with RLQ pain. All MR examinations were performed with a 1.5-or 3.0-T system. Images were acquired without breath holding by using multiplanar half-Fourier singleshot T2-weighted imaging without and with spectral adiabatic inversion recovery fat suppression without oral or intravenous contrast material. MR imaging room time was measured for each patient. Prospective image interpretations from clinical records were reviewed to document acute appendicitis or other causes of abdominal pain. Final clinical outcomes were determined by using (a) surgical results (n = 77), (b) telephone follow-up combined with review of the patient's medical records (n = 291), or (c) consensus expert panel assessment if no follow-up data were available (n = 35). Logistic regression analysis was performed to evaluate the sensitivity and specificity of MR imaging in the detection of acute appendicitis, and corresponding 95% confidence intervals were determined. Results: Of the 403 patients, 67 had MR imaging findings that were positive for acute appendicitis, and 336 had negative findings. MR imaging had a sensitivity of 97.0% (65 of 67) and a specificity of 99.4% (334 of 336). The mean total room time was 14 minutes (range, 862 minutes). An alternate diagnosis was offered in 173 (51.5%) of 336 patients. Conclusion: MR imaging is a highly sensitive and specific test in the evaluation of patients younger than 50 years with acute RLQ pain that uses a rapid imaging protocol performed without intravenous or oral contrast material.

Original languageEnglish (US)
Pages (from-to)451-460
Number of pages10
JournalRadiology
Volume279
Issue number2
DOIs
StatePublished - May 1 2016

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Appendicitis
Magnetic Resonance Imaging
Pain
Contrast Media
Hospital Emergency Service
Breath Holding
Research Ethics Committees
Informed Consent
Telephone
Abdominal Pain
Medical Records
Consensus
Magnetic Resonance Spectroscopy
Retrospective Studies
Logistic Models
Fats
Regression Analysis
Confidence Intervals
Sensitivity and Specificity

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Accuracy of unenhanced Mr imaging in the Detection of acute appendicitis : Single-institution clinical performance review1. / Petkovska, Iva; Martin, Diego R; Covington, Matthew F.; Urbina, Shannon; Duke, Eugene; Daye, Zhongyin J; Stolz, Lori A.; Keim, Samuel M; Costello, James R.; Chundru, Surya; Arif-Tiwari, Hina; Gilbertson-Dahdal, Dorothy -; Gries, Lynn; Kalb, Bobby T.

In: Radiology, Vol. 279, No. 2, 01.05.2016, p. 451-460.

Research output: Contribution to journalArticle

Petkovska, Iva ; Martin, Diego R ; Covington, Matthew F. ; Urbina, Shannon ; Duke, Eugene ; Daye, Zhongyin J ; Stolz, Lori A. ; Keim, Samuel M ; Costello, James R. ; Chundru, Surya ; Arif-Tiwari, Hina ; Gilbertson-Dahdal, Dorothy - ; Gries, Lynn ; Kalb, Bobby T. / Accuracy of unenhanced Mr imaging in the Detection of acute appendicitis : Single-institution clinical performance review1. In: Radiology. 2016 ; Vol. 279, No. 2. pp. 451-460.
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abstract = "Purpose: To determine the accuracy of unenhanced magnetic resonance (MR) imaging in the detection of acute appendicitis in patients younger than 50 years who present to the emergency department with right lower quadrant (RLQ) pain. Materials and Methods: The institutional review board approved this retrospective study of 403 patients from August 1, 2012, to July 30, 2014, and waived the informed consent requirement. A cross-department strategy was instituted to use MR imaging as the primary diagnostic modality in patients aged 349 years who presented to the emergency department with RLQ pain. All MR examinations were performed with a 1.5-or 3.0-T system. Images were acquired without breath holding by using multiplanar half-Fourier singleshot T2-weighted imaging without and with spectral adiabatic inversion recovery fat suppression without oral or intravenous contrast material. MR imaging room time was measured for each patient. Prospective image interpretations from clinical records were reviewed to document acute appendicitis or other causes of abdominal pain. Final clinical outcomes were determined by using (a) surgical results (n = 77), (b) telephone follow-up combined with review of the patient's medical records (n = 291), or (c) consensus expert panel assessment if no follow-up data were available (n = 35). Logistic regression analysis was performed to evaluate the sensitivity and specificity of MR imaging in the detection of acute appendicitis, and corresponding 95{\%} confidence intervals were determined. Results: Of the 403 patients, 67 had MR imaging findings that were positive for acute appendicitis, and 336 had negative findings. MR imaging had a sensitivity of 97.0{\%} (65 of 67) and a specificity of 99.4{\%} (334 of 336). The mean total room time was 14 minutes (range, 862 minutes). An alternate diagnosis was offered in 173 (51.5{\%}) of 336 patients. Conclusion: MR imaging is a highly sensitive and specific test in the evaluation of patients younger than 50 years with acute RLQ pain that uses a rapid imaging protocol performed without intravenous or oral contrast material.",
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T1 - Accuracy of unenhanced Mr imaging in the Detection of acute appendicitis

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AU - Petkovska, Iva

AU - Martin, Diego R

AU - Covington, Matthew F.

AU - Urbina, Shannon

AU - Duke, Eugene

AU - Daye, Zhongyin J

AU - Stolz, Lori A.

AU - Keim, Samuel M

AU - Costello, James R.

AU - Chundru, Surya

AU - Arif-Tiwari, Hina

AU - Gilbertson-Dahdal, Dorothy -

AU - Gries, Lynn

AU - Kalb, Bobby T

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N2 - Purpose: To determine the accuracy of unenhanced magnetic resonance (MR) imaging in the detection of acute appendicitis in patients younger than 50 years who present to the emergency department with right lower quadrant (RLQ) pain. Materials and Methods: The institutional review board approved this retrospective study of 403 patients from August 1, 2012, to July 30, 2014, and waived the informed consent requirement. A cross-department strategy was instituted to use MR imaging as the primary diagnostic modality in patients aged 349 years who presented to the emergency department with RLQ pain. All MR examinations were performed with a 1.5-or 3.0-T system. Images were acquired without breath holding by using multiplanar half-Fourier singleshot T2-weighted imaging without and with spectral adiabatic inversion recovery fat suppression without oral or intravenous contrast material. MR imaging room time was measured for each patient. Prospective image interpretations from clinical records were reviewed to document acute appendicitis or other causes of abdominal pain. Final clinical outcomes were determined by using (a) surgical results (n = 77), (b) telephone follow-up combined with review of the patient's medical records (n = 291), or (c) consensus expert panel assessment if no follow-up data were available (n = 35). Logistic regression analysis was performed to evaluate the sensitivity and specificity of MR imaging in the detection of acute appendicitis, and corresponding 95% confidence intervals were determined. Results: Of the 403 patients, 67 had MR imaging findings that were positive for acute appendicitis, and 336 had negative findings. MR imaging had a sensitivity of 97.0% (65 of 67) and a specificity of 99.4% (334 of 336). The mean total room time was 14 minutes (range, 862 minutes). An alternate diagnosis was offered in 173 (51.5%) of 336 patients. Conclusion: MR imaging is a highly sensitive and specific test in the evaluation of patients younger than 50 years with acute RLQ pain that uses a rapid imaging protocol performed without intravenous or oral contrast material.

AB - Purpose: To determine the accuracy of unenhanced magnetic resonance (MR) imaging in the detection of acute appendicitis in patients younger than 50 years who present to the emergency department with right lower quadrant (RLQ) pain. Materials and Methods: The institutional review board approved this retrospective study of 403 patients from August 1, 2012, to July 30, 2014, and waived the informed consent requirement. A cross-department strategy was instituted to use MR imaging as the primary diagnostic modality in patients aged 349 years who presented to the emergency department with RLQ pain. All MR examinations were performed with a 1.5-or 3.0-T system. Images were acquired without breath holding by using multiplanar half-Fourier singleshot T2-weighted imaging without and with spectral adiabatic inversion recovery fat suppression without oral or intravenous contrast material. MR imaging room time was measured for each patient. Prospective image interpretations from clinical records were reviewed to document acute appendicitis or other causes of abdominal pain. Final clinical outcomes were determined by using (a) surgical results (n = 77), (b) telephone follow-up combined with review of the patient's medical records (n = 291), or (c) consensus expert panel assessment if no follow-up data were available (n = 35). Logistic regression analysis was performed to evaluate the sensitivity and specificity of MR imaging in the detection of acute appendicitis, and corresponding 95% confidence intervals were determined. Results: Of the 403 patients, 67 had MR imaging findings that were positive for acute appendicitis, and 336 had negative findings. MR imaging had a sensitivity of 97.0% (65 of 67) and a specificity of 99.4% (334 of 336). The mean total room time was 14 minutes (range, 862 minutes). An alternate diagnosis was offered in 173 (51.5%) of 336 patients. Conclusion: MR imaging is a highly sensitive and specific test in the evaluation of patients younger than 50 years with acute RLQ pain that uses a rapid imaging protocol performed without intravenous or oral contrast material.

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