MRI REDUCES THE RATE OF DIAGNOSTIC LAPAROSCOPY IN PREGNANT PATIENTS WITH SUSPECTED ACUTE APPENDICITIS
Beatrice Lukenaite*1, Raminta Luksaite-Lukste1,2, Saulius Mikalauskas1,2, Kestutis Strupas1,2, Tomas Poskus1,2
1Faculty of Medicine, Vilnius University, Vilnius, Lithuania; 2Vilnius University Hospital Santara Clinics, Vilnius, Lithuania
Purpose: The purpose of our study was to evaluate the sensitivity, specificity and diagnostic value of magnetic resonance imaging (MRI) in pregnant patients with clinically suspected appendicitis and to identify, whether MRI reduces the rate of unnecessary laparoscopy.
Methods: Consecutive pregnant patients with a suspected acute appendicitis treated at a tertiary institution were included in the study. Transabdominal ultrasound (US) was the initial test used in all women. If appendicitis was not excluded after the US, laparoscopy was performed. MRI was introduced as a diagnostic tool from 2017. Patients, who underwent MRI after an inconclusive ultrasound formed the study group. Patients, who did not undergo MRI form the control group. Demographic, clinical, laboratory, radiology and surgical characteristics were evaluated and compared between the groups. Laparoscopy was considered unnecessary when no inflamed appendix was found. Regional Bioethics committee approved the study.
Results: 76 women were included in the study. 39 women underwent MRI after the inconclusive US. The appendix was visualized in 89.5% (34/38) of MRI, and only in 23.4% (11/36) on the US. There were 5 true-positive cases, 0 false-positive cases, 32 true-negative cases, and 1 false-negative case of acute appendicitis on MRI after the US. The MRI has a sensitivity of 100%, a specificity of 93,9%, a positive predictive value of 71,4%, and a negative predictive value of 100% for the detection of acute appendicitis. One of 39 (2.6%) women underwent unnecessary laparoscopy in the study group vs. 10 of 37 (27.0%) in the control group, p=0.005.
Conclusions: MRI has high sensitivity and specificity for acute appendicitis in pregnant women and significantly reduces the rate of unnecessary laparoscopy in pregnant patients. It should be used in cases, when US is not able to rule out acute appendicitis.
Key words: Pregnancy; Magnetic resonance imaging; Ultrasound; Appendicitis.
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