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Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis

  • Gastrointestinal
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Abstract

Objectives

To evaluate the value of diffusion-weighted MRI (DWI) in the diagnosis of acute appendicitis.

Methods

119 patients with acute appendicitis and 50 controls were enrolled in this prospective study. DWI was obtained with b factors 0, 500 and 1000 s/mm² and were assessed with a visual scoring system by two radiologists followed by quantitative evaluation of the DW images and ADC maps.

Results

Histopathology revealed appendicitis in 79/92 patients (78%) who had undergone surgery. On visual evaluation, except for one patient with histopathologically proven appendicitis all inflamed appendixes were hyperintense on DWI (98.7%). Quantitative evaluation with DW signal intensities and ADC values revealed a significant difference with normal and inflamed appendixes (p < 0.001). The best discriminative parameter was signal intensity (b 500). With a cut-off value of 56 for the signal intensity the ratio had a sensitivity of 99% and a specificity of 97%. The cut-off ADC value at 1.66 mm²/s had a sensitivity of 97% and a specificity of 99%.

Conclusion

DWI is a valuable technique for the diagnosis of acute appendicitis with both qualitative and quantitative evaluation. DWI increases the conspicuity of the inflamed appendix. We recommend using DWI to diagnose acute appendicitis.

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References

  1. Brown JJ (1991) Acute appendicitis: the radiologist’s role. Radiology 180:13–14

    PubMed  CAS  Google Scholar 

  2. Birnbaum BA, Wilson SR (2000) Appendicitis at the millennium. Radiology 215:337–339

    PubMed  CAS  Google Scholar 

  3. Bongard F, Landers DV, Lewis F (1985) Differential diagnosis of appendicitis and pelvic inflammatory disease. A prospective analysis. Am J Surg 150:90–96

    Article  PubMed  CAS  Google Scholar 

  4. Lau WY, Fan ST, Yiu TF, Chu KW, Wong SH (1984) Negative findings at appendectomy. Am J Surg 148:375–378

    Article  PubMed  CAS  Google Scholar 

  5. Binnebösel M, Otto J, Stumpf M et al (2009) Acute appendicitis. Modern diagnostics—surgical ultrasound. Chirurg 80:579–587

    Article  PubMed  Google Scholar 

  6. Lally KP, Cox CS Jr, Andrassy RJ (2004) Appendix. In: Townsend CM Jr, Mattox KL, Evers BM et al (eds) Sabiston textbook of surgery, 17th edn. Saunders, New York, pp 1381–1395

    Google Scholar 

  7. Jeffrey RB Jr, Laing FC, Lewis FR (1987) Acute appendicitis: high-resolution real-time US findings. Radiology 163:11–14

    PubMed  Google Scholar 

  8. Gutierrez CJ, Mariano MC, Faddis DM et al (1999) Doppler ultrasound accurately screens patients with appendicitis. Am Surg 65:1015–1017

    PubMed  CAS  Google Scholar 

  9. Puylaert JB (2003) Ultrasound of the acute abdomen: gastrointestinal conditions. Radiol Clin North Am 41:1227–1242

    Article  PubMed  Google Scholar 

  10. Simonovsky V (1999) Sonographic detection of normal and abnormal appendix. Clin Radiol 54:533–599

    Article  PubMed  CAS  Google Scholar 

  11. Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94

    Article  PubMed  Google Scholar 

  12. Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM (2006) MR imaging evaluation of acute appendicitis in pregnancy. Radiology 238:891–899

    Article  PubMed  Google Scholar 

  13. Bammer R (2003) Basic principles of diffusion-weighted imaging. Eur J Radiol 45:169–184

    Article  PubMed  Google Scholar 

  14. Le Bihan D (1990) Diffusion/perfusion MR imaging of the brain: from structure to function. Radiology 177:328–329

    PubMed  Google Scholar 

  15. Basser PJ, Jones DK (2002) Diffusion tensor MRI: theory, experimental design and data analysis. NMR Biomed 15:456–467

    Article  PubMed  Google Scholar 

  16. Thoeny HC, De Keyzer F (2007) Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol 17:1385–1393

    Article  PubMed  Google Scholar 

  17. Yamashita Y, Tang Y, Takahashi M (1998) Ultrafast MR imaging of the abdomen: echo planar imaging and diffusion-weighted imaging. J Magn Reson Imaging 8:367–374

    Article  PubMed  CAS  Google Scholar 

  18. Kwee TC, Takahara T, Ochiai R, Nievelstein RA, Luijten PR (2008) Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS): features and potential applications in oncology. Eur Radiol 18:1937–1952

    Article  PubMed  Google Scholar 

  19. Kele PG, van der Jagt EJ (2010) Diffusion weighted imaging in the liver. World J Gastroenterol 16:1567–1576

    Article  PubMed  Google Scholar 

  20. Muraoka N, Uematsu H, Kimura H et al (2008) Apparent diffusion coefficient in pancreatic cancer: characterization and histopathological correlations. J Magn Reson Imaging 27:1302–1308

    Article  PubMed  Google Scholar 

  21. Albiston E (2002) The role of radiological imaging in the diagnosis of acute appendicitis. Can J Gastroenterol 16:451–463

    PubMed  CAS  Google Scholar 

  22. Forsted DH, Kalbhen CL (2002) CT of pregnant women for urinary tract calculi, pulmonary thromboembolism and acute appendicitis. AJR Am J Roentgenol 178:1285

    PubMed  Google Scholar 

  23. Nitta N, Takahashi M, Furukawa A, Murata K, Mori M, Fukushima M (2005) MR imaging of the normal appendix and acute appendicitis. J Magn Reson Imaging 21:156–165

    Article  PubMed  Google Scholar 

  24. Hormann M, Paya K, Eibenberger K et al (1998) MR imaging in children with nonperforated acute appendicitis: value of unenhanced MR imaging in sonographically selected cases. AJR Am J Roentgenol 171:467–470

    PubMed  CAS  Google Scholar 

  25. Cobben L, Groot I, Kingma L, Coerkamp E, Puylaert J, Blickman J (2009) A simple MRI protocol in patients with clinically suspected appendicitis: results in 138 patients and effect on outcome of appendectomy. Eur Radiol 19:1175–1183

    Article  PubMed  Google Scholar 

  26. Takahara T, Imai Y, Yamashita T, Yasuda S, Nasu S, Van Cauteren M (2004) Diffusion weighted whole body imaging with background body signal suppression (DWIBS): technical improvement using free breathing, STIR and high resolution 3D display. Radiat Med 22:275–282

    PubMed  Google Scholar 

  27. Naganawa S, Sato C, Kumada H et al (2005) Apparent diffusion coefficient in cervical cancer of the uterus: comparison with the normal uterine cervix. Eur Radiol 15:71–78

    Article  PubMed  Google Scholar 

  28. Tamai K, Koyama T, Saga T et al (2007) Diffusion-weighted MR imaging of uterine endometrial cancer. J Magn Reson Imaging 26:682–687

    Article  PubMed  Google Scholar 

  29. Kilickesmez O, Atilla S, Soylu A et al (2009) Diffusion-weighted imaging of the rectosigmoid colon: preliminary findings. J Comput Assist Tomogr 33:863–866

    Article  PubMed  Google Scholar 

  30. Oto A, Zhu F, Kulkarni K, Karczmar GS, Turner JR, Rubin D (2009) Evaluation of diffusion-weighted MR imaging for detection of bowel inflammation in patients with Crohn’s disease. Acad Radiol 16:597–603

    Article  PubMed  Google Scholar 

  31. Kiryu S, Dodanuki K, Takao H et al (2009) Free-breathing diffusion-weighted imaging for the assessment of inflammatory activity in Crohn’s disease. J Magn Reson Imaging 29:880–886

    Article  PubMed  Google Scholar 

  32. Chan JH, Tsui EY, Luk SH et al (2001) MR diffusion-weighted imaging of kidney: differentiation between hydronephrosis and pyonephrosis. Clin Imaging 25:110–113

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey

    Ercan Inci, Elif Hocaoglu, Sibel Aydin, Sibel Bayramoglu & Tan Cimilli

  2. Department of Radiology, Yeditepe University, School of Medicine, Istanbul, Turkey

    Ozgur Kilickesmez

Authors
  1. Ercan Inci
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  2. Ozgur Kilickesmez
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  3. Elif Hocaoglu
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  4. Sibel Aydin
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  5. Sibel Bayramoglu
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  6. Tan Cimilli
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Correspondence to Ercan Inci.

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Inci, E., Kilickesmez, O., Hocaoglu, E. et al. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol 21, 768–775 (2011). https://doi.org/10.1007/s00330-010-1981-6

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  • DOI: https://doi.org/10.1007/s00330-010-1981-6

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