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MR Imaging of Acute Appendicitis

  • Victoria Chernyak
Chapter

Abstract

Magnetic resonance imaging (MRI) is highly accurate for the diagnosis of acute appendicitis. Lack of ionizing radiation and high contrast resolution makes MRI an attractive alternative to ultrasound and CT in pediatric and pregnant patients. This chapter discusses the literature supporting use of MRI in diagnosis of acute appendicitis, proper MRI technique essential for maximizing diagnostic accuracy, the MRI findings of acute appendicitis, and potential cases of false-positive and false-negative results.

Keywords

Acute appendicitis Magnetic resonance imaging Pediatric population Appendicitis in pregnancy 

References

  1. 1.
    Anderson JE, Bickler SW, Chang DC, Talamini MA. Examining a common disease with unknown etiology: trends in epidemiology and surgical management of appendicitis in California, 1995-2009. World J Surg. 2012;36(12):2787–94.CrossRefGoogle Scholar
  2. 2.
    Smith MP, Katz DS, Lalani T, Carucci LR, Cash BD, Kim DH, et al. ACR appropriateness criteria(R) right lower quadrant pain--suspected appendicitis. Ultrasound Q. 2015;31(2):85–91.CrossRefGoogle Scholar
  3. 3.
    Repplinger MD, Levy JF, Peethumnongsin E, Gussick ME, Svenson JE, Golden SK, et al. Systematic review and meta-analysis of the accuracy of MRI to diagnose appendicitis in the general population. J Magn Reson Imaging. 2016;43(6):1346–54.CrossRefGoogle Scholar
  4. 4.
    Duke E, Kalb B, Arif-Tiwari H, Daye ZJ, Gilbertson-Dahdal D, Keim SM, et al. A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. AJR. 2016;206(3):508–17.CrossRefGoogle Scholar
  5. 5.
    Petkovska I, Martin DR, Covington MF, Urbina S, Duke E, Daye ZJ, et al. Accuracy of unenhanced MR imaging in the detection of acute appendicitis: single-institution clinical performance review. Radiology. 2016;279(2):451–60.CrossRefGoogle Scholar
  6. 6.
    Moore MM, Kulaylat AN, Hollenbeak CS, Engbrecht BW, Dillman JR, Methratta ST. Magnetic resonance imaging in pediatric appendicitis: a systematic review. Pediatr Radiol. 2016;46(6):928–39.CrossRefGoogle Scholar
  7. 7.
    Kulaylat AN, Moore MM, Engbrecht BW, Brian JM, Khaku A, Hollenbeak CS, et al. An implemented MRI program to eliminate radiation from the evaluation of pediatric appendicitis. J Pediatr Surg. 2015;50(8):1359–63.CrossRefGoogle Scholar
  8. 8.
    Koning JL, Naheedy JH, Kruk PG. Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children. Pediatr Radiol. 2014;44(8):948–55.CrossRefGoogle Scholar
  9. 9.
    Burke LM, Bashir MR, Miller FH, Siegelman ES, Brown M, Alobaidy M, et al. Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study. Am J Obstet Gynecol. 2015;213(5):693 e1–6.CrossRefGoogle Scholar
  10. 10.
    Konrad J, Grand D, Lourenco A. MRI: first-line imaging modality for pregnant patients with suspected appendicitis. Abdom Imaging. 2015;40(8):3359–64.CrossRefGoogle Scholar
  11. 11.
    Patel D, Fingard J, Winters S, Low G. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy. Abdom Radiol. 2017;42(7):1857–63.CrossRefGoogle Scholar
  12. 12.
    Amitai MM, Katorza E, Guranda L, Apter S, Portnoy O, Inbar Y, et al. Role of emergency magnetic resonance imaging for the workup of suspected appendicitis in pregnant women. Isr Med Assoc J. 2016;18(10):600–4.PubMedGoogle Scholar
  13. 13.
    Theilen LH, Mellnick VM, Longman RE, Tuuli MG, Odibo AO, Macones GA, et al. Utility of magnetic resonance imaging for suspected appendicitis in pregnant women. Am J Obstet Gynecol. 2015;212(3):345 e1–6.CrossRefGoogle Scholar
  14. 14.
    Moore MM, Kulaylat AN, Brian JM, Khaku A, Hulse MA, Engbrecht BW, et al. Alternative diagnoses at paediatric appendicitis MRI. Clin Radiol. 2015;70(8):881–9.CrossRefGoogle Scholar
  15. 15.
    Dillman JR, Gadepalli S, Sroufe NS, Davenport MS, Smith EA, Chong ST, et al. Equivocal pediatric appendicitis: unenhanced MR imaging protocol for nonsedated children-A clinical effectiveness study. Radiology. 2016;279(1):216–25.CrossRefGoogle Scholar
  16. 16.
    Leeuwenburgh MM, Wiarda BM, Wiezer MJ, Vrouenraets BC, Gratama JW, Spilt A, et al. Comparison of imaging strategies with conditional contrast-enhanced CT and unenhanced MR imaging in patients suspected of having appendicitis: a multicenter diagnostic performance study. Radiology. 2013;268(1):135–43.CrossRefGoogle Scholar
  17. 17.
    Leeuwenburgh MM, Wiezer MJ, Wiarda BM, Bouma WH, Phoa SS, Stockmann HB, et al. Accuracy of MRI compared with ultrasound imaging and selective use of CT to discriminate simple from perforated appendicitis. Br J Surg. 2014;101(1):e147–55.CrossRefGoogle Scholar
  18. 18.
    Rosenkrantz AB, Ginocchio LA, Cornfeld D, Froemming AT, Gupta RT, Turkbey B, et al. Interobserver reproducibility of the PI-RADS version 2 lexicon: a multicenter study of six experienced prostate radiologists. Radiology. 2016;280(3):793–804.CrossRefGoogle Scholar
  19. 19.
    Davenport MS, Khalatbari S, Liu PS, Maturen KE, Kaza RK, Wasnik AP, et al. Repeatability of diagnostic features and scoring systems for hepatocellular carcinoma by using MR imaging. Radiology. 2014;272(1):132–42.CrossRefGoogle Scholar
  20. 20.
    Puylaert CA, Tielbeek JA, Bipat S, Boellaard TN, Nio CY, Stoker J. Long-term performance of readers trained in grading Crohn disease activity using MRI. Acad Radiol. 2016;23(12):1539–44.CrossRefGoogle Scholar
  21. 21.
    Purysko AS, Bittencourt LK, Bullen JA, Mostardeiro TR, Herts BR, Klein EA. Accuracy and interobserver agreement for prostate imaging reporting and data system, version 2, for the characterization of lesions identified on multiparametric MRI of the prostate. AJR. 2017;209(2):339–49.CrossRefGoogle Scholar
  22. 22.
    Leeuwenburgh MM, Wiarda BM, Jensch S, van Es HW, Stockmann HB, Gratama JW, et al. Accuracy and interobserver agreement between MR-non-expert radiologists and MR-experts in reading MRI for suspected appendicitis. Eur J Radiol. 2014;83(1):103–10.CrossRefGoogle Scholar
  23. 23.
    des Ziedses Plantes CM, van Veen MJ, van der Palen J, Klaase JM, Gielkens HA, Geelkerken RH. The effect of unenhanced MRI on the surgeons' decision-making process in females with suspected appendicitis. World J Surg. 2016;40(12):2881–7.CrossRefGoogle Scholar
  24. 24.
    Rapp EJ, Naim F, Kadivar K, Davarpanah A, Cornfeld D. Integrating MR imaging into the clinical workup of pregnant patients suspected of having appendicitis is associated with a lower negative laparotomy rate: single-institution study. Radiology. 2013;267(1):137–44.CrossRefGoogle Scholar
  25. 25.
    Fonseca AL, Schuster KM, Kaplan LJ, Maung AA, Lui FY, Davis KA. The use of magnetic resonance imaging in the diagnosis of suspected appendicitis in pregnancy: shortened length of stay without increase in hospital charges. JAMA Surg. 2014;149(7):687–93.CrossRefGoogle Scholar
  26. 26.
    Lee SM, Ku YM, Choi BG, Byun JY. In vivo location of the vermiform appendix in multidetector CT. J Korean Soc Radiol. 2014;70(4):283–9.CrossRefGoogle Scholar
  27. 27.
    Rosines LA, Chow DS, Lampl BS, Chen S, Gordon S, Mui LW, et al. Value of gadolinium-enhanced MRI in detection of acute appendicitis in children and adolescents. AJR. 2014;203(5):W543–8.CrossRefGoogle Scholar
  28. 28.
    Singh A, Danrad R, Hahn PF, Blake MA, Mueller PR, Novelline RA. MR imaging of the acute abdomen and pelvis: acute appendicitis and beyond. Radiographics. 2007;27(5):1419–31.CrossRefGoogle Scholar
  29. 29.
    Tkacz JN, Anderson SA, Soto J. MR imaging in gastrointestinal emergencies. Radiographics. 2009;29(6):1767–80.CrossRefGoogle Scholar
  30. 30.
    Martin DR, Danrad R, Herrmann K, Semelka RC, Hussain SM. Magnetic resonance imaging of the gastrointestinal tract. Top Magn Reson Imaging. 2005;16(1):77–98.CrossRefGoogle Scholar
  31. 31.
    Kinner S, Repplinger MD, Pickhardt PJ, Reeder SB. Contrast-enhanced abdominal MRI for suspected appendicitis: how we do it. AJR. 2016;207(1):49–57.CrossRefGoogle Scholar
  32. 32.
    Heverhagen JT, Klose KJ. MR imaging for acute lower abdominal and pelvic pain. Radiographics. 2009;29(6):1781–96.CrossRefGoogle Scholar
  33. 33.
    Lyons GR, Renjen P, Askin G, Giambrone AE, Beneck D, Kovanlikaya A. Diagnostic utility of intravenous contrast for MR imaging in pediatric appendicitis. Pediatr Radiol. 2017;47(4):398–403.CrossRefGoogle Scholar
  34. 34.
    Bayraktutan U, Oral A, Kantarci M, Demir M, Ogul H, Yalcin A, et al. Diagnostic performance of diffusion-weighted MR imaging in detecting acute appendicitis in children: comparison with conventional MRI and surgical findings. J Magn Reson Imaging. 2014;39(6):1518–24.CrossRefGoogle Scholar
  35. 35.
    Inci E, Kilickesmez O, Hocaoglu E, Aydin S, Bayramoglu S, Cimilli T. Utility of diffusion-weighted imaging in the diagnosis of acute appendicitis. Eur Radiol. 2011;21(4):768–75.CrossRefGoogle Scholar
  36. 36.
    Lee MH, Eutsler EP, Sheybani EF, Khanna G. Rapid non-contrast magnetic resonance imaging for post appendectomy intra-abdominal abscess in children. Pediatr Radiol. 2017;47(8):935–41.CrossRefGoogle Scholar
  37. 37.
    Swenson DW, Schooler GR, Stamoulis C, Lee EY. MRI of the normal appendix in children: data toward a new reference standard. Pediatr Radiol. 2016;46(7):1003–10.CrossRefGoogle Scholar
  38. 38.
    Kearl YL, Claudius I, Behar S, Cooper J, Dollbaum R, Hardasmalani M, et al. Accuracy of magnetic resonance imaging and ultrasound for appendicitis in diagnostic and nondiagnostic studies. Acad Emerg Med. 2016;23(2):179–85.CrossRefGoogle Scholar
  39. 39.
    Lam M, Singh A, Kaewlai R, Novelline RA. Magnetic resonance of acute appendicitis: pearls and pitfalls. Curr Probl Diagn Radiol. 2008;37(2):57–66.CrossRefGoogle Scholar
  40. 40.
    Shin I, An C, Lim JS, Kim MJ, Chung YE. T1 bright appendix sign to exclude acute appendicitis in pregnant women. Eur Radiol. 2017;27(8):3310–6.CrossRefGoogle Scholar
  41. 41.
    Rosenbaum DG, Askin G, Beneck DM, Kovanlikaya A. Differentiating perforated from non-perforated appendicitis on contrast-enhanced magnetic resonance imaging. Pediatr Radiol. 2017;47(11):1483–90.CrossRefGoogle Scholar
  42. 42.
    Leeuwenburgh MM, Jensch S, Gratama JW, Spilt A, Wiarda BM, Van Es HW, et al. MRI features associated with acute appendicitis. Eur Radiol. 2014;24(1):214–22.CrossRefGoogle Scholar
  43. 43.
    Avcu S, Cetin FA, Arslan H, Kemik O, Dulger AC. The value of diffusion-weighted imaging and apparent diffusion coefficient quantification in the diagnosis of perforated and nonperforated appendicitis. Diagn Interv Radiol. 2013;19(2):106–10.PubMedGoogle Scholar
  44. 44.
    Imler D, Keller C, Sivasankar S, Wang NE, Vasanawala S, Bruzoni M, et al. Magnetic resonance imaging versus ultrasound as the initial imaging modality for pediatric and young adult patients with suspected appendicitis. Acad Emerg Med. 2017;24(5):569–77.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Victoria Chernyak
    • 1
  1. 1.Department of RadiologyMontefiore Medical CenterBronxUSA

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