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Cappuccio M, Bianco P, Rotondo M, Spiezia S, D'Ambrosio M, Menegon Tasselli F, Guerra G, Avella P. Current use of artificial intelligence in the diagnosis and management of acute appendicitis. Minerva Surg 2024; 79:326-338. [PMID: 38477067 DOI: 10.23736/s2724-5691.23.10156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
INTRODUCTION Acute appendicitis is a common and time-sensitive surgical emergency, requiring rapid and accurate diagnosis and management to prevent complications. Artificial intelligence (AI) has emerged as a transformative tool in healthcare, offering significant potential to improve the diagnosis and management of acute appendicitis. This review provides an overview of the evolving role of AI in the diagnosis and management of acute appendicitis, highlighting its benefits, challenges, and future perspectives. EVIDENCE ACQUISITION We performed a literature search on articles published from 2018 to September 2023. We included only original articles. EVIDENCE SYNTHESIS Overall, 121 studies were examined. We included 32 studies: 23 studies addressed the diagnosis, five the differentiation between complicated and uncomplicated appendicitis, and 4 studies the management of acute appendicitis. CONCLUSIONS AI is poised to revolutionize the diagnosis and management of acute appendicitis by improving accuracy, speed and consistency. It could potentially reduce healthcare costs. As AI technologies continue to evolve, further research and collaboration are needed to fully realize their potential in the diagnosis and management of acute appendicitis.
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Affiliation(s)
- Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Paolo Bianco
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Marco Rotondo
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Salvatore Spiezia
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Marco D'Ambrosio
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | | | - Germano Guerra
- V. Tiberio Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
| | - Pasquale Avella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy -
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
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Thanh Thi Nguyen T, Mai Duy Le H, Thanh Nguyen D, Quang Nguyen H, Hoang Nguyen N, Tan Vo D, Cong Phan C. The Role of Magnetic Resonance Pulse Sequences in the Diagnosis of Acute Appendicitis in Pregnant Women. Cureus 2023; 15:e51312. [PMID: 38288189 PMCID: PMC10823294 DOI: 10.7759/cureus.51312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2023] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION Acute appendicitis (AA) is one of the most common surgical emergencies, with a lifetime risk estimated at 7-8%. Pregnant women with appendicitis can have a difficult diagnosis because many signs and symptoms could overlap with other causes of acute abdominal pain. Although magnetic resonance imaging (MRI) is not contraindicated at all gestational ages for units with a field strength of three Tesla or less, there is still much discussion regarding the best protocol to follow in order to minimize survey time and maximize diagnostic efficiency. The purpose of this study was to assess how well different MR pulse sequences can diagnose AA. METHODS This retrospective study involved 179 pregnant females. All patients treated and admitted to the University Medical Center, Ho Chi Minh City, Vietnam, between January 2016 and October 2023 had their MR scans and medical data examined. MRI results were assessed and compared with surgical and histopathological findings. RESULTS The mean age of the population was 29.7 ± 4.8 years (range, 18-46 years). On T1-weighted (T1W) and T2-weighted (T2W) sequences, the appendix was clearly visualized at rates of 81.8% and 89.9%, respectively. The sensitivity and specificity of the T2W in diagnosing AA were 93.5% and 92.3%, and when combined with T1W and diffusion-weighted (DW) images, the sensitivity and specificity further increased, being 96.8% and 94.9%, respectively. The predictive value of non-AA of the T1 bright appendix sign was 95.6%. CONCLUSION Our study supports the use of MRI as an imaging test to identify appendicitis during pregnancy, as it has been shown to be a useful method for diagnosing the condition in pregnant women. The T2W pulse sequence is a useful tool for diagnosing appendicitis because of its high sensitivity and specificity. When identifying appendicitis from T2W alone proves challenging, T1W with the T1 bright sign and DW to take advantage of the appendix lumen and/or wall's diffusion features can yield additional information and boost diagnostic confidence.
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Affiliation(s)
- Thien Thanh Thi Nguyen
- Department of Diagnostic Imaging, University Medical Center of Ho Chi Minh City, Ho Chi Minh, VNM
| | - Huyen Mai Duy Le
- Department of Diagnostic Imaging, University Medical Center of Ho Chi Minh City, Ho Chi Minh, VNM
| | - Duy Thanh Nguyen
- Department of Diagnostic Imaging, University Medical Center of Ho Chi Minh City, Ho Chi Minh, VNM
| | - Hieu Quang Nguyen
- Department of Diagnostic Imaging, University Medical Center of Ho Chi Minh City, Ho Chi Minh, VNM
| | - Nam Hoang Nguyen
- Department of Diagnostic Imaging, University Medical Center of Ho Chi Minh City, Ho Chi Minh, VNM
| | - Duc Tan Vo
- Department of Diagnostic Imaging, University Medical Center of Ho Chi Minh City, Ho Chi Minh, VNM
| | - Chien Cong Phan
- Department of Diagnostic Imaging, University Medical Center of Ho Chi Minh City, Ho Chi Minh, VNM
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Masselli G, Bonito G, Gigli S, Ricci P. Imaging of Acute Abdominopelvic Pain in Pregnancy and Puerperium-Part II: Non-Obstetric Complications. Diagnostics (Basel) 2023; 13:2909. [PMID: 37761275 PMCID: PMC10528125 DOI: 10.3390/diagnostics13182909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Emergency imaging in pregnancy and puerperium poses unique challenges both for clinicians and radiologists, requiring timely and accurate diagnosis. Delay in treatment may result in poor outcomes for both the patient and the foetus. Pregnant and puerperal patients may present in the emergency setting with acute abdominopelvic pain for various complications that can be broadly classified into obstetric and non-obstetric related diseases. Ultrasonography (US) is the primary diagnostic imaging test; however, it may be limited due to the patient's body habitus and the overlapping of bowel loops. Computed tomography (CT) carries exposure to ionising radiation to the foetus, but may be necessary in selected cases. Magnetic resonance imaging (MRI) is a valuable complement to US in the determination of the etiology of acute abdominal pain and can be used in most settings, allowing for the identification of a broad spectrum of pathologies with a limited protocol of sequences. In this second section, we review the common non-obstetric causes for acute abdominopelvic pain in pregnancy and post partum, offering a practical approach for diagnosis and pointing out the role of imaging methods (US, MRI, CT) with the respective imaging findings.
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Affiliation(s)
- Gabriele Masselli
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
| | - Giacomo Bonito
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
| | - Silvia Gigli
- Department of Diagnostic Imaging, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157 Rome, Italy;
| | - Paolo Ricci
- Department of Emergency Radiology-Policlinico Umberto I Hospital, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (G.M.); (P.R.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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Motavaselian M, Bayati F, Amani-Beni R, Khalaji A, Haghverdi S, Abdollahi Z, Sarrafzadeh A, Rafie Manzelat AM, Rigi A, Arabzadeh Bahri R, Nakhaee Z, Fadaei M, Ghasemi Falaverjani H, Malekpour-Dehkordi S, Hoseinpour M, Bidares M, Zandkarimi S, Ahmadi R, Beheshtiparvar D, Ahadiat SA, Farshi M, Farrokhi M. Diagnostic Performance of Magnetic Resonance Imaging for Detection of Acute Appendicitis in Pregnant Women; a Systematic Review and Meta-Analysis. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e81. [PMID: 36426165 PMCID: PMC9676701 DOI: 10.22037/aaem.v10i1.1727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The diagnosis of acute appendicitis (AA) in pregnant women is commonly challenging owing to the normal results of laboratory tests, organ displacement, and normal physiological inflammatory alterations. This meta-analysis aimed to investigate the accuracy of magnetic resonance imaging (MRI) in diagnosis of AA in pregnant women. METHODS Two investigators independently performed a comprehensive systematic literature search of electronic databases including MEDLINE, Cochrane Central, EMBASE, Web of Science, Scopus, and Google Scholar to identify studies that reported accuracy of MRI for diagnosis of AA in pregnant women from inception to April 1, 2022. RESULTS Our systematic search identified a total of 525 published papers. Finally, a total of 26 papers were included in the meta-analysis. The pooled sensitivity and specificity of MRI in diagnosis of AA in pregnant women were 0.92 (95% CI: 0.88-0.95) and 0.98 (95% CI 0.97-0.98), respectively. The pooled positive likelihood ratio and negative likelihood ratio were 29.52 (95% CI: 21.90-39.81) and 0.10 (95% CI: 0.04-0.25), respectively. The area under hierarchical summary receiver operating characteristic (HSROC) curve indicated that the accuracy of MRI for diagnosis of AA in pregnant women is 99%. CONCLUSION This meta-analysis showed that MRI has high sensitivity, specificity, and accuracy for diagnosis of AA in pregnant women and can be used as a first-line imaging modality for suspected cases of AA during pregnancy. Furthermore, it should be noted that when the result of ultrasonography is inconclusive, the use of MRI can reduce unnecessary appendectomy in pregnant patients.
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Affiliation(s)
- Mohsen Motavaselian
- School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fateme Bayati
- USERN Office, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Reza Amani-Beni
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirreza Khalaji
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sara Haghverdi
- Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Arash Sarrafzadeh
- School of Dentistry, Arak University of Medical Sciences, Arak, Iran
| | | | - Amir Rigi
- Islamic Azad University, Zahedan Branch, Zahedan, Iran
| | | | | | - Mahta Fadaei
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hajar Ghasemi Falaverjani
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Matin Bidares
- Islamic Azad University of Najafabad, Najafabad, Iran
| | - Sarvenaz Zandkarimi
- Faculty of Pharmacy, Islamic Azad University of Tehran Medical Sciences, Tehran, Iran
| | - Rasha Ahmadi
- Shariati Hospital, Tehran University of Medical Science, Tehran, Iran
| | | | - Seyed-Amirabbas Ahadiat
- Research Center of Biochemistry and Nutrition in Metabolic Disorder, Kashan University of Medical science. Kashan, Iran
| | - Mohsen Farshi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrdad Farrokhi
- Men’s Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Corresponding author: Mehrdad Farrokhi; Men’s Health and Reproductive Health Research Center, Shohadaye Tajrish Hospital, Tehran, Iran. , Phone number: +989384226664
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