title: Evaluation of MRI for the diagnosis of appendicitis during pregnancy when ultrasound is inconclusive.
abstract: BACKGROUND
  To retrospectively evaluate the diagnostic performance and clinical utility of magnetic resonance imaging (MRI) in pregnant patients suspected of having acute appendicitis, when an ultrasound study generated an inconclusive result.
  
  
  METHODS
  The medical records of 19 consecutive women who underwent abdominal and pelvic MRI at a tertiary care referral center (St. Paul's Hospital, Vancouver, Canada), as part of the work up of clinically suspected acute appendicitis, were retrospectively reviewed. MRI was carried out when ultrasound findings were inconclusive. MRI findings were reviewed and compared with surgical findings and clinical follow-up data including pregnancy outcome.
  
  
  RESULTS
  One of the 19 patients (5.3%) in the study cohort had an appendicitis diagnosed by MRI that was confirmed at operation and by specimen histology. The remaining study patients were diagnosed as not having appendicitis by MRI. These patients were followed until delivery, which was uneventful for all but one patient who was found to have appendicitis during Cesarean section. Overall, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of MRI for the diagnosis of appendicitis during pregnancy was 50.0%, 100%, 100%, 94.4%, and 94.7%, respectively. In three patients (16.7%) with no MRI evidence of appendicitis, MRI identified an alternative etiology for their abdominal pain (two patients diagnosed with ovarian cysts, one patient diagnosed with a uterine fibroid).
  
  
  CONCLUSIONS
  MRI represents a useful diagnostic test for acute appendicitis in pregnant women, and decreases the need for an emergency operation. Its high negative predictive value makes MRI useful for ruling out appendicitis in pregnant patients who have an inconclusive ultrasound. However, the low sensitivity observed in this study suggests that MRI, like other imaging modalities, is not perfect, and may miss an acute appendicitis diagnosis. Thus, future prospective clinical study of MRI as a diagnostic test for the evaluation of women who present with acute abdominal pain and possible appendicitis during pregnancy is warranted.
authors: Department of Surgery, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
authors: Lan
authors: L
authors: Vu
authors: Devon
authors: D
authors: Ambrose
authors: Patrick
authors: P
authors: Vos
authors: Pari
authors: P
authors: Tiwari
authors: Mark
authors: M
authors: Rosengarten
authors: Sam
authors: S
authors: Wiseman
mesh_terms: D000328:Adult; D001064:Appendicitis / Q000175:diagnosis*; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D055815:Young Adult