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European Radiology
Published in: European Radiology 1/2014

01-01-2014 | Gastrointestinal

MRI features associated with acute appendicitis

Authors: Marjolein M. N. Leeuwenburgh, Sebastiaan Jensch, Jan W. C. Gratama, Aart Spilt, Bart M. Wiarda, H. Wouter Van Es, Lodewijk P. J. Cobben, Patrick M. M. Bossuyt, Marja A. Boermeester, Jaap Stoker, on behalf of the OPTIMAP study group

Published in: European Radiology | Issue 1/2014

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Abstract

Objectives

To identify MRI features associated with appendicitis.

Methods

Features expected to be associated with appendicitis were recorded in consensus by two expert radiologists on 223 abdominal MRIs in patients with suspected appendicitis. Nine MRI features were studied: appendix diameter >7 mm, appendicolith, peri-appendiceal fat infiltration, peri-appendiceal fluid, absence of gas in the appendix, appendiceal wall destruction, restricted diffusion of the appendiceal wall, lumen or focal fluid collections. Appendicitis was assigned as the final diagnosis in 117/223 patients. Associations between imaging features and appendicitis were evaluated with logistic regression analysis.

Results

All investigated features were significantly associated with appendicitis in univariate analysis. Combinations of two and three features were associated with a probability of appendicitis of 88 % and 92 %, respectively. In patients without any of the nine features, appendicitis was present in 2 % of cases. After multivariate analysis, only an appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall were significantly associated with appendicitis. The probability of appendicitis was 96 % in their presence and 2 % in their absence.

Conclusions

An appendix diameter >7 mm, peri-appendiceal fat infiltration and restricted diffusion of the appendiceal wall have the strongest association with appendicitis on MRI.

Key points

• An enlarged appendix, fat infiltration and restricted diffusion are associated with appendicitis.
• One such feature on MRI gives an 88 % probability of appendicitis.
• Two features in combination give a probability of appendicitis of 94 %.
• Combinations of three features give a probability of appendicitis of 96 %.
• The absence of these features almost rules out appendicitis (2 %).
Appendix
Available only for authorised users
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Metadata
Title
MRI features associated with acute appendicitis
Authors
Marjolein M. N. Leeuwenburgh
Sebastiaan Jensch
Jan W. C. Gratama
Aart Spilt
Bart M. Wiarda
H. Wouter Van Es
Lodewijk P. J. Cobben
Patrick M. M. Bossuyt
Marja A. Boermeester
Jaap Stoker
on behalf of the OPTIMAP study group
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-3001-0

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