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Inoue A, Nitta N, Ota S, Takaki K, Imai Y, Misaki S, Iwai T, Sonoda A, Mukaisho KI, Murata K. MR Imaging-based Evaluation of Mesenteric Ischemia Caused by Strangulated Small Bowel Obstruction and Mesenteric Venous Occlusion: An Experimental Study Using Rabbits. Magn Reson Med Sci 2020; 19:125-134. [PMID: 31061268 PMCID: PMC7232033 DOI: 10.2463/mrms.mp.2019-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE This study assessed the MRI findings of strangulated small bowel obstruction (SBO) and mesenteric venous occlusion (MVO) in a rabbit model using 3T MRI. MATERIALS AND METHODS Twenty rabbits were included in this study. The strangulated SBO and MVO models were generated via surgical procedures in nine rabbits, and sham surgery was performed in two rabbits. The success of generating the models was confirmed via angiographic, macroscopic, and microscopic findings after the surgical procedure. MRI was performed before and 30 min after inducing mesenteric ischemia. T1-weighted images (T1WIs), T2-weighted images (T2WIs), and fat-suppressed T2WIs (FS-T2WIs) were obtained using the BLADE technique, and fat-suppressed T1WIs (FS-T1WIs) were obtained. The signal intensities of the affected bowel before and after the surgical procedures were visually categorized as high, iso, and low intense compared with the findings for the normal bowel wall on all sequences. Bowel wall thickness was measured, and the signal intensity ratio (SI ratio) was calculated using the signal intensities of the bowel wall and psoas muscle. RESULTS Angiographic, macroscopic, and microscopic findings confirmed that all surgical procedures were successful. The ischemic bowel wall was thicker than the normal bowel. The bowel wall was thicker in the MVO model (3.17 ± 0.55 mm) than in the strangulated SBO model (2.26 ± 0.46 mm). The signal intensity and SI ratio of the bowel wall were significantly higher after the procedure than before the procedure on all sequences in both models. The mesentery adjacent to the ischemic bowel loop exhibited a high signal intensity in all animals on FS-T2WIs. CONCLUSION Non-contrast MRI can be used to evaluate mesenteric ischemia caused by strangulated SBO and MVO. FS-T2WIs represented the best modality for depicting the high signal intensity in the bowel wall and mesentery caused by ischemia.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science
| | - Yugo Imai
- Department of Radiology, Shiga University of Medical Science
| | - Sayaka Misaki
- Department of Radiology, Shiga University of Medical Science
| | - Takayasu Iwai
- Department of Radiology, Shiga University of Medical Science
| | - Akinaga Sonoda
- Department of Radiology, Shiga University of Medical Science
| | - Ken-Ichi Mukaisho
- Division of Molecular and Diagnostic Pathology, Shiga University of Medical Science
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science
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Di Saverio S, Podda M, De Simone B, Ceresoli M, Augustin G, Gori A, Boermeester M, Sartelli M, Coccolini F, Tarasconi A, De' Angelis N, Weber DG, Tolonen M, Birindelli A, Biffl W, Moore EE, Kelly M, Soreide K, Kashuk J, Ten Broek R, Gomes CA, Sugrue M, Davies RJ, Damaskos D, Leppäniemi A, Kirkpatrick A, Peitzman AB, Fraga GP, Maier RV, Coimbra R, Chiarugi M, Sganga G, Pisanu A, De' Angelis GL, Tan E, Van Goor H, Pata F, Di Carlo I, Chiara O, Litvin A, Campanile FC, Sakakushev B, Tomadze G, Demetrashvili Z, Latifi R, Abu-Zidan F, Romeo O, Segovia-Lohse H, Baiocchi G, Costa D, Rizoli S, Balogh ZJ, Bendinelli C, Scalea T, Ivatury R, Velmahos G, Andersson R, Kluger Y, Ansaloni L, Catena F. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World J Emerg Surg 2020; 15:27. [PMID: 32295644 PMCID: PMC7386163 DOI: 10.1186/s13017-020-00306-3] [Citation(s) in RCA: 430] [Impact Index Per Article: 107.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 03/30/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Acute appendicitis (AA) is among the most common causes of acute abdominal pain. Diagnosis of AA is still challenging and some controversies on its management are still present among different settings and practice patterns worldwide. In July 2015, the World Society of Emergency Surgery (WSES) organized in Jerusalem the first consensus conference on the diagnosis and treatment of AA in adult patients with the intention of producing evidence-based guidelines. An updated consensus conference took place in Nijemegen in June 2019 and the guidelines have now been updated in order to provide evidence-based statements and recommendations in keeping with varying clinical practice: use of clinical scores and imaging in diagnosing AA, indications and timing for surgery, use of non-operative management and antibiotics, laparoscopy and surgical techniques, intra-operative scoring, and peri-operative antibiotic therapy. METHODS This executive manuscript summarizes the WSES guidelines for the diagnosis and treatment of AA. Literature search has been updated up to 2019 and statements and recommendations have been developed according to the GRADE methodology. The statements were voted, eventually modified, and finally approved by the participants to the consensus conference and by the board of co-authors, using a Delphi methodology for voting whenever there was controversy on a statement or a recommendation. Several tables highlighting the research topics and questions, search syntaxes, and the statements and the WSES evidence-based recommendations are provided. Finally, two different practical clinical algorithms are provided in the form of a flow chart for both adults and pediatric (< 16 years old) patients. CONCLUSIONS The 2020 WSES guidelines on AA aim to provide updated evidence-based statements and recommendations on each of the following topics: (1) diagnosis, (2) non-operative management for uncomplicated AA, (3) timing of appendectomy and in-hospital delay, (4) surgical treatment, (5) intra-operative grading of AA, (6) ,management of perforated AA with phlegmon or abscess, and (7) peri-operative antibiotic therapy.
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Affiliation(s)
- Salomone Di Saverio
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
- Department of General Surgery, University of Insubria, University Hospital of Varese, ASST Sette Laghi, Regione Lombardia, Varese, Italy.
| | - Mauro Podda
- Department of General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Belinda De Simone
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan-Bicocca, Milan, Italy
| | - Goran Augustin
- Department of Surgery, University Hospital Centre of Zagreb, Zagreb, Croatia
| | - Alice Gori
- Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - Marja Boermeester
- Department of Surgery, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Federico Coccolini
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Antonio Tarasconi
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
| | - Nicola De' Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor University Hospital, Paris, France
| | - Dieter G Weber
- Trauma and General Surgeon Royal Perth Hospital & The University of Western Australia, Perth, Australia
| | - Matti Tolonen
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Arianna Birindelli
- Department of General Surgery, Azienda Socio Sanitaria Territoriale, di Valle Camonica, Italy
| | - Walter Biffl
- Queen's Medical Center, University of Hawaii, Honolulu, HI, USA
| | - Ernest E Moore
- Denver Health System - Denver Health Medical Center, Denver, USA
| | - Michael Kelly
- Acute Surgical Unit, Canberra Hospital, ACT, Canberra, Australia
| | - Kjetil Soreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - Jeffry Kashuk
- Department of Surgery, University of Jerusalem, Jerusalem, Israel
| | - Richard Ten Broek
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carlos Augusto Gomes
- Department of Surgery Hospital Universitario, Universidade General de Juiz de Fora, Juiz de Fora, Brazil
| | | | - Richard Justin Davies
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK
| | - Dimitrios Damaskos
- Department of Upper GI Surgery, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
| | - Ari Leppäniemi
- Department of Abdominal Surgery, Abdominal Center, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, UPMC-Presbyterian, Pittsburgh, USA
| | - Gustavo P Fraga
- Faculdade de Ciências Médicas (FCM) - Unicamp, Campinas, SP, Brazil
| | - Ronald V Maier
- Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA, USA
| | - Raul Coimbra
- UCSD Health System - Hillcrest Campus Department of Surgery Chief Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, San Diego, CA, USA
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Gabriele Sganga
- Department of Emergency Surgery, "A. Gemelli Hospital", Catholic University of Rome, Rome, Italy
| | - Adolfo Pisanu
- Department of General and Emergency Surgery, Cagliari University Hospital, Cagliari, Italy
| | - Gian Luigi De' Angelis
- Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Edward Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry Van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Francesco Pata
- Department of Surgery, Nicola Giannettasio Hospital, Corigliano-Rossano, and La Sapienza University of Rome, Rome, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies "GF Ingrassia", Cannizzaro Hospital, University of Catania, Catania, Italy
| | | | - Andrey Litvin
- Department of Surgery, Immanuel Kant Baltic Federal University, Kaliningrad, Russia
| | - Fabio C Campanile
- Department of Surgery, San Giovanni Decollato Andosilla Hospital, Viterbo, Italy
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Gia Tomadze
- Department of Surgery, Tbilisi State Medical University, TSMU, Tbilisi, Georgia
| | - Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, TSMU, Tbilisi, Georgia
| | - Rifat Latifi
- Section of Acute Care Surgery, Westchester Medical Center, Department of Surgery, New York Medical College, Valhalla, NY, USA
| | - Fakri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | | | | | - Gianluca Baiocchi
- Surgical Clinic, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - David Costa
- Hospital universitario de Alicante, departamento de Cirugia General, Alicante, Spain
| | - Sandro Rizoli
- Department of Surgery, St. Michael Hospital, University of Toronto, Toronto, Canada
| | - Zsolt J Balogh
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | - Cino Bendinelli
- Department of Traumatology, John Hunter Hospital and University of Newcastle, Newcastle, NSW, Australia
| | | | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA
| | - George Velmahos
- Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Luca Ansaloni
- Department of General Surgery and Trauma, Bufalini Hospital, Cesena, Italy
| | - Fausto Catena
- Emergency and Trauma Surgery Department, Maggiore Hospital of Parma, Parma, Italy
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Rafiei M, Mohammad Gholi Mezerji N, Shayan Z, Mosayebi G. The accuracy of white blood cell count in the diagnosis of acute appendicitis using age-sex-adjusted receiver operating characteristic approach. Med J Islam Repub Iran 2020; 33:139. [PMID: 32280645 PMCID: PMC7137840 DOI: 10.34171/mjiri.33.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Indexed: 11/05/2022] Open
Abstract
Background: White blood cell (WBC) counts are commonly used for the diagnosis of acute appendicitis in the early stages of pain. However, the effect of certain confounders, particularly age and sex, has been less focused. The purpose of this study was to investigate the diagnostic accuracy of white blood cells in the prediction of acute appendicitis using age-sex-adjusted receiver operating characteristic (ROC) curve. Methods: In this cross sectional study, 131 patients who had undergone appendectomy were studied during 2010-2011. Patients were placed in the normal appendix and acute appendicitis groups. ROC regression was used to identify the effects of the variables of age and sex on the diagnostic accuracy of WBCs using the area under the ROC curve (AUC). Statistical analysis was conducted in Stata 12 software. Results: In ROC regression method, the AUC for the variable of WBC was 0.643 (95% CI: 0.555-0.725) without adjustment for age and sex variables, 0.672 (0.584-0.751) with an age-adjusted variable, 0.698 (0.612-0.775) with a sex-adjusted variable, and 0.710 (0.624-0.786) with both age-sex adjusted variables. Conclusion: Results indicated that age-sex adjusted variables increased the diagnostic accuracy of the WBC test for predicting acute appendicitis using ROC regression method for the WBC test.
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Affiliation(s)
- Mohammad Rafiei
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Naser Mohammad Gholi Mezerji
- Department of Biostatistics, Student Research Committee, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Zahra Shayan
- Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ghasem Mosayebi
- Department of Immunology and Microbiology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
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Mata-Mbemba D, Rohringer T, Ibrahim A, Adams-Webberc T, Moineddin R, Doria AS, Vali R. HR-pQCT imaging in children, adolescents and young adults: Systematic review and subgroup meta-analysis of normative data. PLoS One 2019; 14:e0225663. [PMID: 31834887 PMCID: PMC6910691 DOI: 10.1371/journal.pone.0225663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022] Open
Abstract
We aimed to investigate the methodologies on image acquisition of normative data of high-resolution peripheral quantitative computed tomography (HR-pQCT) in children, adolescents and/or young adults (up to 25 years) and to determine their normative data based on available literature. A literature search was conducted in MEDLINE, EMBASE and Web of Science from 1947 to July 2019. Quality of articles was assessed using Standards for Reporting of Diagnostic Accuracy (STARD) scoring system and Modified Newcastle-Ottawa scale (NOS). Articles which fitted the following criteria were combined to meta-analysis: age range (15 to 22.6 years), references at tibia (22.5mm) and/or radius (9.0 to 9.5mm). Eight articles were ultimately included in the systematic review and 4 of them that filled the criteria were summarised in meta-analysis. The results of random effects model of HR-pQCT parameters of the 4 articles were as follows: 1)Radius: bone volume fraction (BT/BV) [estimate 0.17:0.1229(lower)-0.2115 (upper); trabecular number (Tb_N):2.08(2.03–2.12); trabecular thickness (Tb.Th):0.07 (0.07–0.0.08); trabecular separation (Tb.Sp):0.41 (0.38–0.42); cortical thickness (Ct.Th):0.85 (0.76–0.94); cortical porosity (Ct.Po):1.53 (0.63–2.44); total area (Tt.Ar):263.66(-385.3–912.6); total bone density (Tt-vBMD):280.5 (73.1–487.7); Trabecular density (Tb-vBMD):223.6 (47.1–400.09), and cortical density (CT.vBMD):765.9 (389.1–1142.8). 2)Tibia: BT/BV:0.18 (0.17–0.19); Tb_N:2.02 (1.83–2.2); Tb.Th:0.08 (0.80–0.09); Tb.Sp:0.40(0.36–0.44); Ct.Th:1.32(1.26–1.38); Ct.Po:3.15 (1.1–5.2); Tt.Ar:693.1(150.2–1235.8); Tt-vBMD:343.76 (335.5–352.1); Tb-vBMD:223.6 (213.37 (193.5–233.2), and CT.vBMD:894.3 (857.6–931.1). There is overall ‘fair’ evidence on reporting of results of normative data of HR-pQCT parameters in children, adolescents and/or young adults. However, data are scarce pointing out to the urgent need for standardization of acquisition parameters and guidelines on the use of HR-PQCT in these populations.
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Affiliation(s)
- Daddy Mata-Mbemba
- Department of Diagnostic Imaging, IWK Health Centre, and Department of Diagnostic Radiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
- * E-mail:
| | | | - Ala Ibrahim
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Rahim Moineddin
- Departments of Family and Community Medicine (R.M.), University of Toronto, Toronto, Canada
| | - Andrea S. Doria
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Reza Vali
- Department of Diagnostic Imaging, Hospital for Sick Children and Department of Medical Imaging, University of Toronto, Toronto, Canada
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Mahankali SK, Abdel Razek AAK, Ahamed SA. Reliability of standardized reporting system of acute appendicitis in adults at low-dose 320-rows CT. Eur J Radiol Open 2019; 6:330-335. [PMID: 31768408 PMCID: PMC6872863 DOI: 10.1016/j.ejro.2019.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 12/26/2022] Open
Abstract
Aim To assess the reliability of a standardized reporting system of acute appendicitis at low-dose 320-rows CT. Subjects and Methods Retrospective analysis CT of 78 patients with pathologically proven acute appendicitis. The study was performed at a low-dose 320-rows CT. The image analysis was performed by 2 radiologists according to a standardized reporting system of acute appendicitis. Results There was an excellent overall of the inter-observer agreement of both observers for the standardized reporting system of acute appendicitis (K = 0.89, 95 % CI = 0.87-0.92, P = 0.001). There was good inter-observer agreement for visualization of the appendix (K = 0.78, P = 0.001), the tip diameter (K = 0.75, P = 0.001), and a single wall thickness of appendix (K = 0.77, P = 0.001). There was excellent inter-observer agreement for outer to outer wall diameter (K = 0.82, P = 0.001), mucosal hyper-enhancement (K = 0.80, P = 0.001), appendicolith (K = 0.86, P = 0.001), gas in the appendix (K = 0.82, P = 0.001), surrounding fat stranding (K = 0.81, P = 0.001), focal cecal thickening (K = 0.85, P = 0.001), peri-appendiceal air (K = 0.87, P = 0.001), peri-appendicular fluid collection, phlegmon, or abscess (K = 0.82, P = 0.001), and right ovary cyst (K = 0.83, P = 0.001). Conclusion we concluded that excellent reliability of a standardized reporting system of acute appendicitis in the adults using low-dose 320-rows CT.
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Shen G, Wang J, Fei F, Mao M, Mei Z. Bedside ultrasonography for acute appendicitis: An updated diagnostic meta-analysis. Int J Surg 2019; 70:1-9. [PMID: 31404675 DOI: 10.1016/j.ijsu.2019.08.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/28/2019] [Accepted: 08/06/2019] [Indexed: 12/12/2022]
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Inoue A, Furukawa A, Nitta N, Takaki K, Ota S, Zen Y, Kojima M, Akabori H, Ohta H, Mekata E, Saotome T, Murata K. Accuracy, criteria, and clinical significance of visual assessment on diffusion-weighted imaging and apparent diffusion coefficient quantification for diagnosing acute appendicitis. Abdom Radiol (NY) 2019; 44:3235-3245. [PMID: 31420704 DOI: 10.1007/s00261-019-02180-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To assess the accuracy, criteria, and clinical significance of diffusion-weighted imaging (DWI) signal intensity and apparent diffusion coefficient (ADC) quantification for diagnosing acute appendicitis. METHODS Fifty-one patients with right lower abdominal pain [uncomplicated appendicitis (n = 25), complicated appendicitis (n = 10), and non-appendicitis (n = 16)] who underwent MR examination were enrolled in this retrospective study. Two radiologists independently measured appendiceal diameter and wall thickness. They assessed whether a wall defect, an abscess, extraluminal air, or an appendicolith was present on axial T2WI; evaluated intensity on DWI using a 5-point scale; and determined the ADC values of the appendix and peri-appendiceal tissue. Statistical analysis was performed to assess imaging findings for the diagnosis of appendicitis and complicated appendicitis. Cut-off values were determined using receiver operating characteristic analysis. RESULTS For diagnosing acute appendicitis, the accuracy improved from 78.4% using only T2WI to 86.3% using combined T2WI and DWI for reader 1 and from 82.4 to 86.3% for reader 2. For the appendix, the cut-off ADC values that diagnosed appendicitis were 1.41 × 10-3 and 1.26 × 10-3 mm2/s with accuracies of 78.4% and 76.5%, respectively. For the peri-appendiceal tissue, these values of 1.03 × 10-3 and 0.91 × 10-3 mm2/s differentiated between uncomplicated and complicated appendicitis with an accuracy of 97.1%. CONCLUSIONS Combined DWI and T2WI provided high accuracy for diagnosing appendicitis. The inflamed appendix had lower ADC value than the normal appendix. The peri-appendiceal tissue presenting low ADC value was a notable finding of complicated appendicitis.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, National Hospital Organization, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-0044, Japan.
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
| | - Akira Furukawa
- Department of Radiological Science, Tokyo Metropolitan University, Higashi-Oku, Arakawa-ku, Tokyo, 116-0012, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Kai Takaki
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Shinichi Ota
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
| | - Yumi Zen
- Department of Surgery, National Hospital Organization, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-0044, Japan
| | - Masatsugu Kojima
- Department of Surgery, National Hospital Organization, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-0044, Japan
| | - Hiroya Akabori
- Department of Surgery, National Hospital Organization, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-0044, Japan
| | - Hiroyuki Ohta
- Department of Surgery, National Hospital Organization, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-0044, Japan
| | - Eiji Mekata
- Department of Surgery, National Hospital Organization, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-0044, Japan
| | - Takao Saotome
- Department of Emergency, National Hospital Organization, Higashi-Ohmi General Medical Center, 255 Gochi-cho, Higashiomi, Shiga, 527-0044, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Seta, Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan
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Saillant NN, Kilcoyne A, Fagenholz PJ, Lui R, Krystel-Whittemore M. Case 25-2019: A 41-Year-Old Pregnant Woman with Abdominal Pain. N Engl J Med 2019; 381:656-664. [PMID: 31412181 DOI: 10.1056/nejmcpc1900596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Noelle N Saillant
- From the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Massachusetts General Hospital, and the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Harvard Medical School - both in Boston
| | - Aoife Kilcoyne
- From the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Massachusetts General Hospital, and the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Harvard Medical School - both in Boston
| | - Peter J Fagenholz
- From the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Massachusetts General Hospital, and the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Harvard Medical School - both in Boston
| | - Raymond Lui
- From the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Massachusetts General Hospital, and the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Harvard Medical School - both in Boston
| | - Melissa Krystel-Whittemore
- From the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Massachusetts General Hospital, and the Departments of Surgery (N.N.S., P.J.F.), Radiology (A.K.), Obstetrics and Gynecology (R.L.), and Pathology (M.K.-W.), Harvard Medical School - both in Boston
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Jones RE, Gee KM, Preston SC, Babb JL, Beres AL. Diagnostic Utilization and Accuracy of Pediatric Appendicitis Imaging at Adult and Pediatric Centers. J Surg Res 2019; 240:97-103. [DOI: 10.1016/j.jss.2019.02.047] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/29/2019] [Accepted: 02/22/2019] [Indexed: 12/29/2022]
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Kave M, Parooie F, Salarzaei M. Pregnancy and appendicitis: a systematic review and meta-analysis on the clinical use of MRI in diagnosis of appendicitis in pregnant women. World J Emerg Surg 2019; 14:37. [PMID: 31367227 PMCID: PMC6647167 DOI: 10.1186/s13017-019-0254-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this systematic review and meta-analysis was to evaluate the clinical use of MRI for the evaluation of acute appendicitis during pregnancy. Methods The searches were conducted by two independent researchers (MK, MS) to find the relevant studies published from 1/1/2009 until end of 30/12/2018. We searched for published literature in the English language in MEDLINE via PubMed, EMBASETM via Ovid, The Cochrane Library, and Trip database. For literature published in other languages, we searched national databases (Magiran and SID), KoreaMed, and LILACS. The keywords used in the search strategy are Pregnancy [MeSH], Pregnant [MeSH] OR-Magnetic resonance imaging [MeSH] OR-Appendicitis [MeSH] OR-Ultrasound, [MeSH] OR, imaging, MRI [MeSH] OR"،" and Right lower quadrant pain [MeSH]. The risk of bias of every article was evaluated by using QUADAS-2. On the basis of the results from the 2 × 2 tables, pooled measures for sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curves (AUC) along with their 95% confidence intervals (CIs) were calculated using the DerSimonian Lair methodology. Results As many as 1164 studies were selected. After analyzing the correspondence of the studies with the required criteria, 19 studies were selected for the final review. For appendicitis in pregnancy, the MRI sensitivity was 91.8% at the 95% confidence interval of (95% CI 87.7-94.9%). At the confidence interval of 95%, the specificity was 97.9% (95% CI 0.97.2-100%). The risk of bias in the studies conducted was measured using the QUADAS-2 tool. Conclusion MRI has high sensitivity and specificity (91.8%, 97.9% respectively) for the diagnosis of acute appendicitis in pregnant patients with clinically suspected appendicitis. It is an excellent imaging technique in many instances, which does not expose a fetus, or the mother, to ionizing radiation, making it an excellent option for pregnant patients with suspected acute appendicitis.
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Affiliation(s)
- Mania Kave
- 1Gynecology and Obstetrics Institution, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Islamic Republic of Iran
| | - Fateme Parooie
- 2Student Research Committee, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Islamic Republic of Iran
| | - Morteza Salarzaei
- 2Student Research Committee, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Islamic Republic of Iran
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Jha P, Espinoza N, Webb E, Kohli M, Poder L, Morgan T. Single institutional experience with initial ultrasound followed by computed tomography or magnetic resonance imaging for acute appendicitis in adults. Abdom Radiol (NY) 2019; 44:2357-2365. [PMID: 30949783 DOI: 10.1007/s00261-019-01998-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE The objectives of this study was to assess the performance of ultrasound (US) for suspected appendicitis in adult patients and to evaluated the additive value of short-interval (within 1 week) computed tomography (CT) or Magnetic Resonance Imaging (MRI) after performing an initial US. METHODS In this IRB-approved, HIPAA-compliant, retrospective study, electronic medical records (EMRs) were queried for "US appendicitis" performed over a 2-year interval. EMR was reviewed for CT or MRI performed within 1 week of this exam, and if any new or additional information was available at subsequent exam. White count, patient disposition, and pathology, if surgery was performed, were also recorded. RESULTS 682 patients underwent US for appendicitis over a 2-year duration, age range from 18 to 92 years (average: 30.1 years, M:F = 141:541). Findings showed 126/682 patients with normal appendix, 75/682 uncomplicated appendicitis, and 4/682 with complicated appendicitis. When performed, no additional findings were seen in these groups on short-interval CT or MRI. 2/682 patients had equivocal findings on US but eventually had normal appendix identified on CT. Four hundred and seventy-three patients had non-visualized appendix, of which only 14/473 (3.1%) eventually had appendicitis. CONCLUSIONS Ultrasound is an effective initial modality for evaluating appendicitis even in adult patients. Once a normal appendix, uncomplicated or complicated appendicitis is identified on US, no further imaging is necessary. Very few patients with non-visualization of the appendix eventually have appendicitis. Hence, these patients can be managed with active clinical follow-up rather than immediate CT or MRI. Symptoms and clinical scoring systems can be used for triage of these patients.
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Affiliation(s)
- Priyanka Jha
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94131, USA.
| | - Nora Espinoza
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94131, USA
| | - Emily Webb
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94131, USA
| | - Marc Kohli
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94131, USA
| | - Liina Poder
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94131, USA
| | - Tara Morgan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Box 0628, San Francisco, CA, 94131, USA
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Dillman JR, Trout AT. MRI for First-Line Evaluation of Children Suspected of Having Acute Appendicitis. Radiology 2019; 291:178-179. [DOI: 10.1148/radiol.2019190056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jonathan R. Dillman
- From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229; and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Andrew T. Trout
- From the Department of Radiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229; and Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Mervak BM, Wilson SB, Handly BD, Altun E, Burke LM. MRI of acute appendicitis. J Magn Reson Imaging 2019; 50:1367-1376. [PMID: 30883988 DOI: 10.1002/jmri.26709] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/21/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Benjamin M. Mervak
- University of North Carolina Department of RadiologyDivision of Abdominal Imaging Chapel Hill North Carolina USA
| | - Sarah B. Wilson
- University of North Carolina Radiology Residency Program Chapel Hill North Carolina USA
| | - Brian D. Handly
- University of North Carolina Department of RadiologyDivision of Pediatric Imaging Chapel Hill North Carolina USA
| | - Ersan Altun
- University of North Carolina Department of RadiologyDivision of Abdominal Imaging Chapel Hill North Carolina USA
| | - Lauren M. Burke
- University of North Carolina Department of RadiologyDivision of Abdominal Imaging Chapel Hill North Carolina USA
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Mushtaq R, Desoky SM, Morello F, Gilbertson-Dahdal D, Gopalakrishnan G, Leetch A, Vedantham S, Kalb B, Martin DR, Udayasankar UK. First-Line Diagnostic Evaluation with MRI of Children Suspected of Having Acute Appendicitis. Radiology 2019; 291:170-177. [PMID: 30747595 DOI: 10.1148/radiol.2019181959] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Advances in abdominal MRI have enabled rapid, free-breathing imaging without the need for intravenous or oral contrast material. The use of MRI as the primary imaging modality for suspected appendicitis has not been previously studied. Purpose To determine the diagnostic performance of MRI as the initial imaging modality in children suspected of having acute appendicitis. Materials and Methods The study included consecutive patients 18 years of age and younger presenting with acute abdominal pain at a tertiary care institution from January 2013 through June 2016 who subsequently underwent an unenhanced MRI examination as the primary diagnostic imaging modality. Electronic medical records and radiology reports were retrospectively evaluated for the feasibility and diagnostic performance of MRI, with surgical pathology and follow-up electronic records as reference standards. Statistical analyses were performed by using simple binomial proportions to quantify sensitivity, specificity, and accuracy, and exact 95% confidence intervals (CIs) were obtained. Results After exclusions, 402 patients (median age: 13 years; interquartile range [IQR], 9-15 years; 235 female patients; 167 male patients) were included. Sedation for MRI was required in 13 of 402 patients (3.2%; 95% CI: 1.7%, 5.5%). The appendix was visualized in 349 of 402 patients (86.8%; 95% CI: 83.1%, 90%); for the remaining patients, a diagnosis was provided on the basis of secondary signs of appendicitis. The sensitivity, specificity, and accuracy of MRI as the primary diagnostic imaging modality for the evaluation of acute appendicitis were 97.9% (95 of 97; 95% CI: 92.8%, 99.8%), 99% (302 of 305; 95% CI: 97.2%, 99.8%), and 98.8% (397 of 402; 97.1%, 99.6%), respectively. Among patients with negative findings for appendicitis at MRI, an alternate diagnosis was provided in 113 of 304 patients (37.2%; 95% CI: 31.7%, 42.9%). Conclusion When performed as the initial imaging modality in children suspected of having acute appendicitis, MRI examinations had high diagnostic performance for the diagnosis of acute appendicitis and in providing alternative diagnoses. © RSNA, 2019 See also the editorial by Dillman and Trout in this issue.
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Affiliation(s)
- Raza Mushtaq
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Sarah M Desoky
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Frank Morello
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Dorothy Gilbertson-Dahdal
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Geetha Gopalakrishnan
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Aaron Leetch
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Srinivasan Vedantham
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Bobby Kalb
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Diego R Martin
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
| | - Unni K Udayasankar
- From the Departments of Medical Imaging (R.M., S.M.D., F.M., D.G., S.V., B.K., D.R.M., U.K.U.), Pediatrics (G.G.), and Pediatric Emergency Medicine (A.L.), University of Arizona College of Medicine, 1501 N Campbell Ave, Tucson, AZ 85724
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Khan U, Kitar M, Krichen I, Maazoun K, Ali Althobaiti R, Khalif M, Adwani M. To determine validity of ultrasound in predicting acute appendicitis among children keeping histopathology as gold standard. Ann Med Surg (Lond) 2018; 38:22-27. [PMID: 30591836 PMCID: PMC6305696 DOI: 10.1016/j.amsu.2018.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/14/2018] [Accepted: 11/30/2018] [Indexed: 12/04/2022] Open
Abstract
Background To determined the accuracy of ultrasound in diagnosis of acute appendicitis in children keeping histopathology as gold standard. Methods A prospective evaluations of all ultrasound for appendicitis from January 1, 2014, to June 15, 2017, was conducted at our hospital. A diagnostic protocol was implemented to reduce radiation exposure employing US as the initial imaging modality followed by CT for non-diagnostic US studies in patients with an equivocal clinical presentation. The imaging, operative findings, and pathology of 223 patients (females 80, males 143, age less than 14years) with diagnosed appendicitis were collected. The sensitivity, specificity, predictive value, and negative appendectomy rate were also analyzed. All those patients which had subjected to surgery were included to evaluate the true result of ultrasound in diagnosis of appendicitis. Results Of the 223 pediatric appendectomies performed in this time period, a total of 192 (86%) were diagnosed by ultrasound. The histopathology of 8 was normal (3.6%), CT done in 11 and three was normal. The negative appendectomy rate was 3.6%. US were the sole imaging modality in all patients. Conclusions In the diagnosis of acute appendicitis in children, ultrasound is useful and accurate mode, which results in a significant decrease in negative appendectomies with no increase in the number of CT scans. This has important implications in the reduction of childhood radiation exposure. Study design cross sectional validation. Total 223 Diagnose as acute appendicitis on initial clinical basis and follow by ultrasound study. All went for surgery, 8 patient negative by histopathology. Diagnosis by ultrasound 192 out of 223, Sensitivity 86%. Accuracy reaches 92% with secondary signs on ultrasound finding.
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Affiliation(s)
- Ubaidullah Khan
- Pediatric Surgery, Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Murad Kitar
- Pediatric Surgery, Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Imed Krichen
- Pediatric Surgery, Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Kais Maazoun
- Pediatric Surgery, Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Rasha Ali Althobaiti
- Pediatric Surgery, Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mostafa Khalif
- Pediatric Surgery, Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
| | - Mohammad Adwani
- Pediatric Surgery, Department of Surgery, Alhada Armed Forces Hospital, Taif, Saudi Arabia
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